73 y/o M who presents with epigastric abdominal pain...Lower GI Bleed • Bleed distal to ligament...
Transcript of 73 y/o M who presents with epigastric abdominal pain...Lower GI Bleed • Bleed distal to ligament...
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73 y/o M who presents with
epigastric abdominal pain
Atul Kumar, MD, MS
Charan K Singh, MBBS.
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Scroll Through Images
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Coronal Non-contrast CT
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Coronal Non-contrast CT
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Coronal Non-contrast CT
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Coronal Non-contrast CT
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Coronal Non-contrast CT
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Coronal Non-contrast CT
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Coronal Non-contrast CT
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Coronal Non-contrast CT
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Coronal Non-contrast CT
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Coronal Non-contrast CT
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Coronal Non-contrast CT
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Coronal Non-contrast CT
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Coronal Contrast CT
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Coronal Contrast CT
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Coronal Contrast CT
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Coronal Contrast CT
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Coronal Contrast CT
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Coronal Contrast CT
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Coronal Contrast CT
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Coronal Contrast CT
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Coronal Contrast CT
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Coronal Contrast CT
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Coronal Contrast CT
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Coronal Contrast CT
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Coronal Contrast CT
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?
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Lower GI Bleed
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Coronal Non-contrast CT
Non-contrast
image
demonstrates no
hypderdense
material
![Page 31: 73 y/o M who presents with epigastric abdominal pain...Lower GI Bleed • Bleed distal to ligament of Treitz • Symptoms: bright red blood per rectum, melena, abdominal pain, nausea](https://reader036.fdocuments.ec/reader036/viewer/2022063013/5fccfcedf7c8776c143bb355/html5/thumbnails/31.jpg)
Coronal Non-contrast CT
Non-contrast
image
demonstrates no
hypderdense
material
![Page 32: 73 y/o M who presents with epigastric abdominal pain...Lower GI Bleed • Bleed distal to ligament of Treitz • Symptoms: bright red blood per rectum, melena, abdominal pain, nausea](https://reader036.fdocuments.ec/reader036/viewer/2022063013/5fccfcedf7c8776c143bb355/html5/thumbnails/32.jpg)
Coronal Non-contrast CT
Non-contrast
image
demonstrates no
hypderdense
material
![Page 33: 73 y/o M who presents with epigastric abdominal pain...Lower GI Bleed • Bleed distal to ligament of Treitz • Symptoms: bright red blood per rectum, melena, abdominal pain, nausea](https://reader036.fdocuments.ec/reader036/viewer/2022063013/5fccfcedf7c8776c143bb355/html5/thumbnails/33.jpg)
Coronal Non-contrast CT
Non-contrast
image
demonstrates no
hypderdense
material
![Page 34: 73 y/o M who presents with epigastric abdominal pain...Lower GI Bleed • Bleed distal to ligament of Treitz • Symptoms: bright red blood per rectum, melena, abdominal pain, nausea](https://reader036.fdocuments.ec/reader036/viewer/2022063013/5fccfcedf7c8776c143bb355/html5/thumbnails/34.jpg)
Coronal Non-contrast CT
Non-contrast
image
demonstrates no
hypderdense
material
![Page 35: 73 y/o M who presents with epigastric abdominal pain...Lower GI Bleed • Bleed distal to ligament of Treitz • Symptoms: bright red blood per rectum, melena, abdominal pain, nausea](https://reader036.fdocuments.ec/reader036/viewer/2022063013/5fccfcedf7c8776c143bb355/html5/thumbnails/35.jpg)
Coronal Non-contrast CT
Non-contrast
image
demonstrates no
hypderdense
material
![Page 36: 73 y/o M who presents with epigastric abdominal pain...Lower GI Bleed • Bleed distal to ligament of Treitz • Symptoms: bright red blood per rectum, melena, abdominal pain, nausea](https://reader036.fdocuments.ec/reader036/viewer/2022063013/5fccfcedf7c8776c143bb355/html5/thumbnails/36.jpg)
Coronal Non-contrast CT
Non-contrast
image
demonstrates no
hypderdense
material
![Page 37: 73 y/o M who presents with epigastric abdominal pain...Lower GI Bleed • Bleed distal to ligament of Treitz • Symptoms: bright red blood per rectum, melena, abdominal pain, nausea](https://reader036.fdocuments.ec/reader036/viewer/2022063013/5fccfcedf7c8776c143bb355/html5/thumbnails/37.jpg)
Coronal Non-contrast CT
Non-contrast
image
demonstrates no
hypderdense
material
![Page 38: 73 y/o M who presents with epigastric abdominal pain...Lower GI Bleed • Bleed distal to ligament of Treitz • Symptoms: bright red blood per rectum, melena, abdominal pain, nausea](https://reader036.fdocuments.ec/reader036/viewer/2022063013/5fccfcedf7c8776c143bb355/html5/thumbnails/38.jpg)
Coronal Non-contrast CT
Non-contrast
image
demonstrates no
hypderdense
material
![Page 39: 73 y/o M who presents with epigastric abdominal pain...Lower GI Bleed • Bleed distal to ligament of Treitz • Symptoms: bright red blood per rectum, melena, abdominal pain, nausea](https://reader036.fdocuments.ec/reader036/viewer/2022063013/5fccfcedf7c8776c143bb355/html5/thumbnails/39.jpg)
Coronal Non-contrast CT
Non-contrast
image
demonstrates no
hypderdense
material
![Page 40: 73 y/o M who presents with epigastric abdominal pain...Lower GI Bleed • Bleed distal to ligament of Treitz • Symptoms: bright red blood per rectum, melena, abdominal pain, nausea](https://reader036.fdocuments.ec/reader036/viewer/2022063013/5fccfcedf7c8776c143bb355/html5/thumbnails/40.jpg)
Coronal Non-contrast CT
Non-contrast
image
demonstrates no
hypderdense
material
![Page 41: 73 y/o M who presents with epigastric abdominal pain...Lower GI Bleed • Bleed distal to ligament of Treitz • Symptoms: bright red blood per rectum, melena, abdominal pain, nausea](https://reader036.fdocuments.ec/reader036/viewer/2022063013/5fccfcedf7c8776c143bb355/html5/thumbnails/41.jpg)
Coronal Non-contrast CT
Non-contrast
image
demonstrates no
hypderdense
material
![Page 42: 73 y/o M who presents with epigastric abdominal pain...Lower GI Bleed • Bleed distal to ligament of Treitz • Symptoms: bright red blood per rectum, melena, abdominal pain, nausea](https://reader036.fdocuments.ec/reader036/viewer/2022063013/5fccfcedf7c8776c143bb355/html5/thumbnails/42.jpg)
Coronal Contrast CT
Contrast
enhanced image
demonstrates
bleed
![Page 43: 73 y/o M who presents with epigastric abdominal pain...Lower GI Bleed • Bleed distal to ligament of Treitz • Symptoms: bright red blood per rectum, melena, abdominal pain, nausea](https://reader036.fdocuments.ec/reader036/viewer/2022063013/5fccfcedf7c8776c143bb355/html5/thumbnails/43.jpg)
Coronal Contrast CT
Contrast
enhanced image
demonstrates
bleed
![Page 44: 73 y/o M who presents with epigastric abdominal pain...Lower GI Bleed • Bleed distal to ligament of Treitz • Symptoms: bright red blood per rectum, melena, abdominal pain, nausea](https://reader036.fdocuments.ec/reader036/viewer/2022063013/5fccfcedf7c8776c143bb355/html5/thumbnails/44.jpg)
Coronal Contrast CT
Contrast
enhanced image
demonstrates
bleed
![Page 45: 73 y/o M who presents with epigastric abdominal pain...Lower GI Bleed • Bleed distal to ligament of Treitz • Symptoms: bright red blood per rectum, melena, abdominal pain, nausea](https://reader036.fdocuments.ec/reader036/viewer/2022063013/5fccfcedf7c8776c143bb355/html5/thumbnails/45.jpg)
Coronal Contrast CT
Contrast
enhanced image
demonstrates
bleed
![Page 46: 73 y/o M who presents with epigastric abdominal pain...Lower GI Bleed • Bleed distal to ligament of Treitz • Symptoms: bright red blood per rectum, melena, abdominal pain, nausea](https://reader036.fdocuments.ec/reader036/viewer/2022063013/5fccfcedf7c8776c143bb355/html5/thumbnails/46.jpg)
Coronal Contrast CT
Contrast
enhanced image
demonstrates
bleed
![Page 47: 73 y/o M who presents with epigastric abdominal pain...Lower GI Bleed • Bleed distal to ligament of Treitz • Symptoms: bright red blood per rectum, melena, abdominal pain, nausea](https://reader036.fdocuments.ec/reader036/viewer/2022063013/5fccfcedf7c8776c143bb355/html5/thumbnails/47.jpg)
Coronal Contrast CT
Contrast
enhanced image
demonstrates
bleed
![Page 48: 73 y/o M who presents with epigastric abdominal pain...Lower GI Bleed • Bleed distal to ligament of Treitz • Symptoms: bright red blood per rectum, melena, abdominal pain, nausea](https://reader036.fdocuments.ec/reader036/viewer/2022063013/5fccfcedf7c8776c143bb355/html5/thumbnails/48.jpg)
Coronal Contrast CT
Contrast
enhanced image
demonstrates
bleed
![Page 49: 73 y/o M who presents with epigastric abdominal pain...Lower GI Bleed • Bleed distal to ligament of Treitz • Symptoms: bright red blood per rectum, melena, abdominal pain, nausea](https://reader036.fdocuments.ec/reader036/viewer/2022063013/5fccfcedf7c8776c143bb355/html5/thumbnails/49.jpg)
Coronal Contrast CT
Contrast
enhanced image
demonstrates
bleed
![Page 50: 73 y/o M who presents with epigastric abdominal pain...Lower GI Bleed • Bleed distal to ligament of Treitz • Symptoms: bright red blood per rectum, melena, abdominal pain, nausea](https://reader036.fdocuments.ec/reader036/viewer/2022063013/5fccfcedf7c8776c143bb355/html5/thumbnails/50.jpg)
Coronal Contrast CT
Contrast
enhanced image
demonstrates
bleed
![Page 51: 73 y/o M who presents with epigastric abdominal pain...Lower GI Bleed • Bleed distal to ligament of Treitz • Symptoms: bright red blood per rectum, melena, abdominal pain, nausea](https://reader036.fdocuments.ec/reader036/viewer/2022063013/5fccfcedf7c8776c143bb355/html5/thumbnails/51.jpg)
Coronal Contrast CT
Contrast
enhanced image
demonstrates
bleed
![Page 52: 73 y/o M who presents with epigastric abdominal pain...Lower GI Bleed • Bleed distal to ligament of Treitz • Symptoms: bright red blood per rectum, melena, abdominal pain, nausea](https://reader036.fdocuments.ec/reader036/viewer/2022063013/5fccfcedf7c8776c143bb355/html5/thumbnails/52.jpg)
Coronal Contrast CT
Contrast
enhanced image
demonstrates
bleed
![Page 53: 73 y/o M who presents with epigastric abdominal pain...Lower GI Bleed • Bleed distal to ligament of Treitz • Symptoms: bright red blood per rectum, melena, abdominal pain, nausea](https://reader036.fdocuments.ec/reader036/viewer/2022063013/5fccfcedf7c8776c143bb355/html5/thumbnails/53.jpg)
Coronal Contrast CT
Contrast
enhanced image
demonstrates
bleed
![Page 54: 73 y/o M who presents with epigastric abdominal pain...Lower GI Bleed • Bleed distal to ligament of Treitz • Symptoms: bright red blood per rectum, melena, abdominal pain, nausea](https://reader036.fdocuments.ec/reader036/viewer/2022063013/5fccfcedf7c8776c143bb355/html5/thumbnails/54.jpg)
Coronal Contrast CT
Contrast
enhanced image
demonstrates
bleed
![Page 55: 73 y/o M who presents with epigastric abdominal pain...Lower GI Bleed • Bleed distal to ligament of Treitz • Symptoms: bright red blood per rectum, melena, abdominal pain, nausea](https://reader036.fdocuments.ec/reader036/viewer/2022063013/5fccfcedf7c8776c143bb355/html5/thumbnails/55.jpg)
Coronal MIP Contrast CT
Contrast
enhanced image
demonstrates
bleed
![Page 56: 73 y/o M who presents with epigastric abdominal pain...Lower GI Bleed • Bleed distal to ligament of Treitz • Symptoms: bright red blood per rectum, melena, abdominal pain, nausea](https://reader036.fdocuments.ec/reader036/viewer/2022063013/5fccfcedf7c8776c143bb355/html5/thumbnails/56.jpg)
Lower GI Bleed
• Bleed distal to ligament of Treitz
• Symptoms: bright red blood per rectum, melena, abdominal
pain, nausea
• Lower GI bleed < Upper GI bleed
• Typical Causes:
– Divertucla
– Angiodysplasia
– Cancer/Polyp
– Colitis
– Fissure/Hemorrhoids
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Lower GI Bleed
• Imaging:
– Nuclear Medicine Imaging
• Tc99m labeled RBCs: detection of bleed with rate ≥ 0.2 mL/min
• Tc99 sulfur colloid: detection of bleed with rate 0.05 – 0.1 mL/min
– CT Angiography: detection of bleed with rate ≥ 0.35 mL/min
– Mesenteric Angiography: detection of bleed with rate > 0.5
mL/min
• Can treat as well
![Page 58: 73 y/o M who presents with epigastric abdominal pain...Lower GI Bleed • Bleed distal to ligament of Treitz • Symptoms: bright red blood per rectum, melena, abdominal pain, nausea](https://reader036.fdocuments.ec/reader036/viewer/2022063013/5fccfcedf7c8776c143bb355/html5/thumbnails/58.jpg)
References
• Laing, Christopher J., et al. “Acute Gastrointestinal Bleeding:
Emerging Role of Multidetector CT Angiography and Review of
Current Imaging Techniques.” RadioGraphics, vol. 27, no. 4, 2007,
pp. 1055–1070., doi:10.1148/rg.274065095.
• Artigas, José M., et al. “Multidetector CT Angiography for Acute
Gastrointestinal Bleeding: Technique and Findings.” RadioGraphics,
vol. 33, no. 5, 2013, pp. 1453–1470., doi:10.1148/rg.335125072.
• Loffroy, Romaric. “Multidetector CT Angiography for the Detection of
Colonic Diverticular Bleeding: When, How, and Why?” Digestive
Diseases and Sciences, vol. 58, no. 7, 2013, pp. 1822–1824.,
doi:10.1007/s10620-013-2710-1.