Morning Report: 6/4/2015

Here’s Dr. Freedman with today’s Morning Report!

The LGIB Toolbox

Why?

Tools for diagnosis and therapy are limited.

• NG Lavage stinks.
• RBC Scan not an ED test
• Colonoscopy has not been shown to be useful.
  • Stable, Prepped and not hemorrhaging?
  • No clinical difference btwn emergent and delayed_5,6
• Surgery is a last-ditch effort.
  • Terrible mortality
  • 25-33% for subtotal colectomy
  • 8% for targeted resection
• IR is good, but….
  • Hard to get
  • Varied diagnostic yield
  • Lots of complications

What else have we got?

CTA for LGIB

Perks:

• Fast and Accurate
  • ~90 sensitive for active bleed (> 0.5cc/min)1
  • 10 minute test₄
• Risk stratify
  • If negative, 77% chance of not rebleeding₃
  • May be a floor candidate?
• Target therapy
  • Makes IR more successful₁
  • Surgery less mortal
• Identify obscure site
• Identfiy LGIB “mimics”

References:

1. Yoon W, Jeong Y Y, Shin S S. et al. Acute massive gastrointestinal bleeding: detection and localization with arterial phase multi-detector row helical CT. Radiology. 2006;239(1):160–167
2. Zink SI, Ohki SK, Stein B, Zambuto DA, Rosenberg RJ, Choi JJ, Tubbs DS. Noninvasive evaluation of active lower gastrointestinal bleeding: comparison between contrast-enhanced MDCT and 99mTc-labeled RBC scintigraphy. AJR Am J Roentgenol. 2008;191:1107–1114
3. Chan, Victoria, et al. “Outcome Following a Negative CT Angiogram for Gastrointestinal Hemorrhage.”Cardiovascular and interventional radiology(2014): 1-7.
4. Copland, Andrew, et al. “Integrating urgent multidetector CT scanning in the diagnostic algorithm of active lower GI bleeding.”Gastrointestinal endoscopy2 (2010): 402-405.
5. Green BT, Rockey DC, Portwood G. Urgent colonoscopy for evaluation and management of acute lower gastrointestinal hemorrhage: a randomized controlled trial. Am J Gastroenterol 2005;100:2395–2402
6. Laine, A. Shah. Randomized trial of urgent vs. elective colonoscopy in patients hospitalized with lower GI bleeding. Am J Gastroenterol, 105 (2010), pp. 2636–2641

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Jay Khadpe MD

Editor in Chief of "The Original Kings of County" Assistant Professor of Emergency Medicine Assistant Residency Director SUNY Downstate / Kings County Hospital

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