PERDARAHAN SALURAN CERNA

BAGIAN BAWAH
 OBJECTIVES :

1. To know Characteristic of LGB

2. To Know the cause of LGB
3. To know how to Diagnose LGB
4. To know the Treatment of LGB
 NO 1.
TO KNOW
CHARACTERISTIC OF LGB
 Definition

• Lower Gastrointestinal Bleeding (LGB)

is bleeding of GIT tract below Treitz
Ligament
• Bright Red Bleed that passed from
anus is called : Hematochezia.
• Chronic Bleeding in a little amount (so
we cannot see) is called Occult
Bleeding
• Maroon stool (Chocolate Black Stool): is
usually bleeding from right colon,
sometimes mixed with melena
• Melena : is a black tarry, foul smelling stool
is usually upper git bleeding
 Severity of Hematochezia

Mild Severe

85%

15%
 Source of Bleeding
Kolon SCBA Usus halus ??

9% 6%

11%

74%
 NO 2.
TO KNOW
THE CAUSE OF LGB
 Etiology of Hematochezia

= Internal Hemorrhoids = Rectal Trauma

= Angiodysplasia = Rectal Varices
= Diverticula = Anal Fissures
= Cancer = Anal Ulcers
= Polyps = Post-polypectomy
= Ulcerative Colitis = External hemorrhoids
= Ischemic Colitis
 Lokasi perdarahan pada penderita
dengan hematokezia berat

• Angiomata 40%
• Diverticulosis 22%
• Polyps or cancer 15%
• Colitis 12%
• Other 11%
 NO 3.
TO KNOW
HOW TO DIAGNOSE LGB
 Anamnesis
The History Should include direct Q :
• Does the blood coat the outside of
formed hard stool?—
Internal Haemorrhoid
• Is it mixed with with stool?
(Internal source)
• Is there bloody diarrhea or
tenesmus? (Colitis)
• Is this a chronic, intermitten or acute
problem?
 Is There any History of:

GIT bleeding Change bw habit

GIT surgery Weight loss
Peptic ulcer Aspirin/NSAID
IBD Alcohol abuse
Ischemic HD Abd pain
Int Haemorr Constipation
Rectal trauma Recent a biotic
Painless Recent Travel
 DIAGNOSTIC & THERAPEUTIC OPTION

1. ANOSCOPY
2. FLEXIBLE SIGMOIDOSCOPY
3. COLONOSCOPY
4. PUSH ENTEROSCOPY
5. BARIUM ENEMA
6. ANGIOGRAPHY
7.NUCLEAR MEDICINA SCINTIGRAPHY
8. SURGICAL
 NEXT STEP

• Measure vital sign: shock, hypotensi

• Abdomen : mass, pain
• Evaluate stool color, RT ; Guaiac test
• Anoskopi
• NGT
• Complete Blood count and
• Blood coagulation test
 NO 4.
TO KNOW
THE TREATMENT OF LGB
 Severity of Hematochezia

Mild Severe

85%

15%
 TREATMENT

• Electrolite Infusion/ To Stabilize

Plasma Expander/ cardiovascular
Blood
• Hemostatic agent
• Endoscopic Therapeutic
• Surgical
 Rectal bleeding

History, physical
examination, laboratory
studies

Intermittent, small amounts of blood no On-going rectal bleeding; shock or

hemodynamic instability; and hematocrit orthostatic hypotension; and hematocrit
bleeding lower than 8% from baseline

Suspect mild lower GI Suspect severe

bleeding bleeding

Nasogastric No blood and

Blood or no bile
aspiration clear bile

Suspect upper GI Suspect lower GI

bleeding bleeding

Admit to ICU; give fluid resuscitation;

correct coaguopathy,
thrombocytopenia; and obtain
gastroenterology or surgery consults
 Mild lower gastrointestinal
bleeding

Age <50 Age > 50

Hemorrhoidal-type bleeding, New hematochezia or

normal hematocrit hemoccult-positive stool

Anoscopy and flexible

Colonoscopy
sigmoidoscopy; if no lesion
found, then air-contrast barium
enema
 Patient with severe lower
GI bleeding

Cannot be stabilized
Medically stabilized
medically

Polyethylene glycol
purge over 3 – 4 hours
Urgent surgery

Colonoscopy If lesion Endoscopic treatment

If negative

Upper Endoscopy If lesion Endoscopic treatment

If negative

Upper endoscopy with

Surgery colonoscope If lesion Endoscopic treatment
(“push enteroscopy”)

If ongoing unexplained Technetium-labelled Repeat endoscopy /

If positive
bleeding Red cell scan angiography / surgery