Lower gastrointestinal bleeding
[History taking].
1.Feces with blood or full blood stool, bright red, dark red or black stool.
2, sweating, thirst, pale skin, wet and cold extremities, dizziness, rapid heartbeat, decreased blood pressure, shock, etc.
3.Past history of systemic diseases such as inflammatory bowel disease, or hematological disease, uremia, or connective tissue disease.
Physical examination]
1. Signs of anemia, such as pale face, wet and cold extremities, thirst, sweating, dizziness, rapid heartbeat, decreased blood pressure, etc.
2. Signs causing bleeding etiology, such as fever, abdominal pressure, abdominal mass, purpura, etc.
Auxiliary examination】
1.Fecal routine, occult blood test, fecal culture.
2.Blood routine, prothrombin time.
3.Anal finger diagnosis and anoscopy, colonoscopy.
4.Oral barium lower gastrointestinal X-ray or barium enema colonography.
5.Radionuclide imaging examination.
6.Selective arteriography is more significant for the diagnosis of small intestine bleeding.
7.CT examination.
Diagnostic points】
1.positive blood in stool or fecal occult blood test.
2.Hemorrhagic anemia or peripheral circulation failure.
3.Laboratory tests to confirm blood loss and anemia.
4.Anal finger examination or special auxiliary examination to confirm the presence of lesions causing bleeding.
Differential diagnosis
1. Differentiate from black feces caused by ingestion of certain foods or drugs.
2.Differentiate from black feces after swallowing of whistling tract bleeding.
3.Differentiate between the causes of lower gastrointestinal bleeding.
Treatment principles
1.General treatment: rest, liquid or semi-liquid diet with less residue, monitor vital signs.
2.Replenish blood volume: according to the amount of bleeding, crystal, colloid or blood transfusion can be used.
3.Hemostasis.
(1) Hemostasis: 1% ephedrine hydrochloride plus saline solution cotton ball compression to stop bleeding, norepinephrine 8mg plus cold saline 100ml retention enema.
(2) Transendoscopic hemostasis Hemostasis by endoscopic injection, hemostatic clip, electrocoagulation, laser, microwave, etc.
(3) Selective arterial cannulation for hemostasis Apply posterior pituitary gland infusion or arterial embolization.
(4) Surgical treatment if the above hemostatic measures are ineffective.
Efficacy criteria
1.Cure: bleeding stops.
2.Improved: bleeding is reduced or intermittent small amount of bleeding.
3.Not cured: those who meet the above criteria.
Discharge criteria
Anyone who has reached the standard of cure can be discharged from the hospital.