 Welcome back to GI Bleed Part 5. In this part, we'll discuss the treatment for lower GI Bleed. As similar to the treatment for upper GI Bleed, there is empiric treatment and specific treatment once we have an idea of the cause of the bleed. Empiric treatment starts with ABC. After ensuring airway and breathing is adequate in the patient who want to tackle circulation. Ivy fluids such as crystallized will be given. And in cases where the patient is bleeding profusely, blood will also be given. Also, if the patient is on anticoagulant, reversal agents should be given as well. And now let's look at the specific treatment for the patients with the specific cause for their lower GI Bleed. As you might remember, the causes for lower GI Bleed include colitis, tumor, angiotysplasia, diverticulosis, hemorrhoids and fissures. First, let's look at colitis. Remember that colitis can be caused by infection, inflammation and ischemia. For infectious colitis, the treatment usually includes identifying what the organism is that causes the infectious colitis. Once the organism is being identified, then antimicrobial should be started. In the emergency department, there often isn't enough time for us to identify the organism. And therefore, we need to obtain a culture of the patient's stool while they're still in the department. For inflammatory colitis, that usually includes ulcerative colitis and Crohn's disease. The treatment for inflammatory colitis includes bowel rest, so the patient is kept NPO. Avifluid is given to ensure the patient is hydrated. And anti-inflammatory medications such as steroids is given to decrease the inflammation in the bowel. There are other specific treatment for inflammatory colitis that we will not be discussing here. For ischemic colitis, it is usually caused by decreased blood supply to the gut. The patient needs to be on bowel rest and therefore they should be NPO. Antibiotics is often given. If there is perforation of the bowel, then the patient will need surgery. For patients who is bleeding due to a colonic mass or a tumor, there is often no specific treatment in the emergency department. If it is also causing an obstruction, then the patient is admitted. Patients should be put on bowel rest and surgery should be consulted about them. Andiodysplasia can be treated by different ways to burn the vessels during colonoscopy. This is not a treatment often done in the emergency department since the patient will need a full bowel prep. How about for diverticulosis? Diverticular bleed can be brisk. Sometimes an embolization can be done by interventional radiology to knock out the blood supply to that particular part of the bowel. If it does not settle down, surgery might be needed to resect the part of the colon with the bleeding diverticulum. And lastly for fissures and hemorrhoids. These tend to bleed during bowel movement and made worse by constipation. We can decrease constipation by increasing fiber intake and give a patient a stool softener. Creamy steroid can decrease the amount of bleeding for internal hemorrhoids. Interestingly, cream with nitroglycerin or calcium channel blockers such as dillet's hyazem have been shown in studies to decrease fissures. Both fissures and hemorrhoids tend to have small amount of lower GI bleed that tend to resolve on its own. In summary, we discussed the empiric and specific treatment of patients with lower GI bleed. Thank you for watching.