emDOCs.net Emergency Medicine (EM) Podcast Episode 96: Lower GI Bleeding
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Mar 6, 2024 Topics covered in the podcast include the causes and distinction of lower GI bleeding from upper GI bleeding, the role of CTA in evaluation, management strategies such as transfusion thresholds and reversal agents, and the importance of timely imaging and resuscitation for unstable patients.
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Lower GI Bleeding Often Stops But Repeats
- Lower GI bleeding is common and usually resolves spontaneously in up to 85% of cases.
- However, re-bleeding occurs in ~40% within a year and ~25% require transfusion, so risk remains significant.
Clinical Clues Differentiate Upper vs Lower Bleeds
- Certain history and exam findings shift likelihood toward upper versus lower GI sources.
- Clots per rectum strongly predict lower GI bleed while melena and high BUN:Cr suggest upper GI origin.
Reserve CTA For Active, Significant Bleeding
- Use CTA (multiphasic) only in patients with hemodynamically significant or ongoing bleeding.
- In stable patients with resolved bleeding, CTA is low-yield and usually unnecessary.