Hemorragia Digestiva Baja 2025: Divertículos, Cáncer de Colon y Manejo Inicial | VILLAMEDIC

🩸 LOWER GASTROINTESTINAL BLEEDING: CAUSES, DIAGNOSIS, AND MANAGEMENT UPDATED 2025 In this educational video, we comprehensively review lower gastrointestinal bleeding (LGIB), from its definition and most frequent causes to the diagnostic and therapeutic approach according to the most recent international guidelines (ACG 2023–2024, BSG). We analyze the main etiologies (diverticulosis, angiodysplasia, hemorrhoids, inflammatory bowel disease, ischemic colitis, polyps, and colorectal cancer), the initial hemodynamic assessment, the use of risk stratification tools (e.g., Oakland score), the role of early colonoscopy, and complementary studies such as CT angiography and arteriography. 📋 VIDEO CONTENT Definition of LGIB and its difference from upper gastrointestinal bleeding (UGIB). Clinical presentation: rectal bleeding, hematochezia, iron deficiency anemia, occasionally hemodynamic instability. COMMON CAUSES Diverticular disease of the colon: most frequent cause of acute lower gastrointestinal bleeding in adults; massive, often painless bleeding. Angiodysplasias and vascular malformations: typical in the elderly and patients with comorbidities (heart disease, chronic kidney disease). Anorectal pathology: internal hemorrhoids, anal fissures (bright red bleeding associated with defecation). Inflammatory bowel disease (IBD) and infectious or ischemic colitis. Polyps and colorectal cancer: chronic bleeding, anemia, changes in bowel habits. INITIAL MANAGEMENT AND STRATIFICATION Immediate hemodynamic assessment: blood pressure, heart rate, signs of shock; Fluid resuscitation with crystalloids and restrictive transfusion (target Hb ≈7 g/dL in stable patients). Use of risk scales (e.g., Oakland) to identify patients eligible for early discharge versus admission. Differentiate lower gastrointestinal bleeding (LGIB) from upper gastrointestinal bleeding (UGIB): hematochezia with hemodynamic instability may correspond to UGIB, therefore upper endoscopy is recommended in these cases. ENDOSCOPIC DIAGNOSIS AND TREATMENT Colonoscopy: the test of choice in most hospitalized patients; early colonoscopy (within 24–48 hours) is recommended after adequate preparation to improve diagnostic yield and therapeutic options. Endoscopic findings and therapy: clipping, injection, and thermal coagulation in diverticula and vascular lesions; polypectomy in bleeding polyps. ADDITIONAL STUDIES AND INTERVENTIONS CT angiography: useful for locating the focus of active bleeding in moderate-to-severe lower gastrointestinal bleeding (LGIB) when colonoscopy is not diagnostic or is not possible. Arteriography with embolization: an option in persistent active bleeding identified by CT angiography. Surgery: segmental or subtotal colectomy as a last resort when endoscopic and interventional measures fail. 🎯 TARGET AUDIENCE Emergency room physicians, internal medicine physicians, and general surgeons. Gastroenterologists and digestive endoscopists. Internal medicine, gastroenterology, and surgical residents. Medical students and emergency/ICU nursing staff. ⚕️ KEY POINTS ✅ LGIB = bleeding distal to the ligament of Treitz; Most cases are self-limiting and have a better prognosis than upper gastrointestinal bleeding (UGIB), but they can be serious. ✅ Most frequent cause in adults: diverticular disease; in the elderly, also angiodysplasia. ✅ Hematochezia with hemodynamic instability requires ruling out UGIB first with upper endoscopy. ✅ Early colonoscopy (24–48 h) after bowel preparation improves diagnosis and allows for endoscopic treatment. ✅ CT angiography and arteriography with embolization are key in persistent bleeding or bleeding of unknown origin after endoscopy. #LowerGIBleeding #RectalBleeding #Hematochezia #Diverticulosis #Angiodysplasia #Hemorrhoids #AnalFissure #ColorectalCancer #ColonPolyps #Colonoscopy #CTAngiography #Arteriography #DigestiveEndoscopy #Gastroenterology #EmergencyDepartment #InternalMedicine #GeneralSurgery #ICU #HemorrhagicShock #Transfusion #EvidenceBasedMedicine #Guidelines2025 #ACG #BSG #VILLAMEDIC #MedicalEducation #MedicalResidency #MedStudentLife #DoctorLife #HighYield #FOAMed