mThe Source: Lower G.I.T. bleeding extending from ligament of Tretez at dudeno-jejunal junction downwards.
mThe Nature:The lower GIT bleeding is usually bright red in colour while upper GIT bleeding give black tarry stool. But, massive upper GIT bleeding may give bright red colour bleeding per rectum.
mCauses:
(I) Congenital:
q Mickle's diverticulum.
qHaemangiomatous malformation "Angiodysplasia"
q Endometriosis.
(II) Post operative:
q Post anorectal surgery: reactionary or secondery hge.
q Post appendicectomy due to slipped ligature of the appenicular stump.
(III) Inflammatory:
Diverticulitis of the colon. Crohn's disease.
Ulcerative type of TB. Bilharzial colitis.
Ulcerative colitis
(IV) Neoplastic:
- Benign Juvenile polyp (common cause in children)
Adenomatous polyp
Familial polposis & Gardner's syndrome
- Malignant Cancer colon & Cancer rectum
(V) Vascular Strangulation:
- Intussusception, Mesentric vascular occlusion, and Ischaemic colitis.
(VI) Local lesions in anal canal:
Internal haemorrhoids "the commonest cause"
Anal fissure."common cause"
m Investigations:
1- PR: To detect local lesion e.g. anal fissure, or cancer colon.
2- Proctoscpy and colonoscopy can detect smaller and distal lesions can't be felt by PR.
3- Selective mesenteric angiography. The dye concentration will be higher in the bleeding vessel. The rate of bleeding can be assessed and surgical interference can be decided.
mTreatment:
q Treatment of shock and blood transfusion.
q Treatment of the cause.
SOURCE: DR. AYMAN SALEM'S BOOK
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