II. Indications
III. Protocol: Timing (Hospitalized patients)
-
Colonoscopy within 12-48 hours
- Allows for adequate Bowel Preparation
- Allows for adequate Resuscitation
IV. Preparation
- Adequate Bowel Preparation is key to diagnosis
- Rapid Bowel Preparation in urgent Colonoscopy (colonic lavage with purge preparation)
- Uses Polyethylene Glycol (PEG 3350, Golytely, Nulytely)
- Polyethylene Glycol at 1 liter every 30-45 minutes for at least 2 hours until clear effluent OR
- Polyethylene Glycol 4 to 6 Liters over 3-4 hours until output without stool or blood
V. Diagnosis: Colonoscopy
- Pitfalls
- Definite bleeding source in suspected Diverticular Bleeding is only identified in 10-20% of cases
- However overall identifies 69-80% of Lower Gastrointestinal Bleeding causes
- High False Positive Rate for wrong site of bleeding
- Sites commonly misdiagnosed as bleeding source
- Definite bleeding source in suspected Diverticular Bleeding is only identified in 10-20% of cases
- Criteria for definitive diagnosis of bleeding source
- Active bleeding
- Nonbleeding visible vessel or pigmented protuberance
- Clot adherent to bleeding source
- Fresh blood in a short colonic segment
- Diverticular ulceration with fresh blood nearby
VI. Signs: Colonoscopy findings on evaluation of Lower Gastrointestinal Bleeding
- Mucosal changes
- Infectious Colitis
- Ischemic Colitis
- Diverticular Bleeding source
VII. Management: Modalities for control of bleeding sites
- Thermal contact probe
- Nd-YAG Laser
- Dilute epinephine injection with electrocautery
- Band ligation or metallic clip placement