{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 31, Ep 2 of 4: Lower GI Bleeding and Mesenteric Ischemia","html":"","width":"100%","height":180,"duration":974,"description":"Episode two moves below the ligament of Treitz and then to the mesenteric vessels, carrying the same rule forward: pick the imaging that feeds the next intervention and recognize the pattern that flips the algorithm. Acute lower GI bleeding branches on hemodynamic stability, CT angiography for the unstable patient because it hands interventional radiology the anatomy and colonoscopy at twelve to twenty-four hours for the stable one, with the etiologies read by pattern. Colon ischemia separates from diverticular bleeding on pain before bleeding, and isolated right colon ischemia flips the workup toward mesenteric imaging. Acute mesenteric ischemia turns on recognizing pain out of proportion to exam and reaching for CT angiography before lactate rises, then matching intervention to each of four etiologies.\n \nTopics covered\n\nAcute lower GI bleeding and the BUN-to-creatinine clue\nHemodynamic split: CT angiography versus colonoscopy\nDiverticular, angiodysplastic, and post-polypectomy bleeding\nEndoscopic hemostasis and the no-serosa rule\nColon ischemia and pain before bleeding\nIsolated right colon ischemia flipping the algorithm\nFour etiologies of acute mesenteric ischemia\nEtiology-specific intervention\nThe lactate trap and initial bundle\n \nKey decisions\n\nSend the hemodynamically unstable lower GI bleeder to CT angiography first because it images extravasation at about zero point three milliliters per minute and gives IR the anatomy for superselective embolization, and send the stable patient to colonoscopy at twelve to twenty-four hours after rapid polyethylene glycol prep.\nSuspect a brisk upper source in about fifteen percent of presumed lower GI bleeds and when the BUN-to-creatinine ratio exceeds thirty, and exclude anorectal sources by anoscopy before colonoscopy referral.\nTreat diverticular and post-polypectomy bleeding with clips or bands rather than deep thermal therapy because the diverticular wall and thinned resection base lack serosa and coagulate to...","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}