Lower gastrointestinal bleeding differential diagnosis

Jump to navigation Jump to search

Lower gastrointestinal bleeding Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Lower gastrointestinal bleeding from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Management

Initial resuscitation
Pharmacotherapy

Surgery

Surgical Management
Endoscopic Intervention

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Guidelines for Management

Case Studies

Case #1

Lower gastrointestinal bleeding differential diagnosis On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Lower gastrointestinal bleeding differential diagnosis

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Lower gastrointestinal bleeding differential diagnosis

CDC on Lower gastrointestinal bleeding differential diagnosis

Lower gastrointestinal bleeding differential diagnosis in the news

Blogs on Lower gastrointestinal bleeding differential diagnosis

Directions to Hospitals Treating Psoriasis

Risk calculators and risk factors for Lower gastrointestinal bleeding differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

Several diseases present with lower gastrointestinal bleeding and must be differented from each other. The common diseases responsible for lower GI bleeding inlcude diverticulosis, angiodysplasia, hemorrhoids, anal fissures, mesenteric Ischemia, ischemic colitis, inflammatory bowel disease, and colo-rectal carcinoma.

Differentiating Lower gastrointestinal bleeding from other Diseases

Several diseases present with lower gastrointestinal bleeding and must be differented from each other. The common diseases responsible for lower GI bleeding inlcude diverticulosis, angiodysplasia, hemorrhoids, anal fissures, mesenteric Ischemia, ischemic colitis, inflammatory bowel disease, and colo-rectal carcinoma.

Disease Symptoms Other features Diagnosis
Abdominal pain Rectal pain Weightloss Fever Type of GI bleeding Diarrhea Constipation Laboratory findings Radio-Imaging findings
Diverticulosis - - - - Red or maroon-colored blood - +
  • Self limiting
  • Seen in elderly
Normal

Globular outpouchings on CT scan

Angiodysplasia - - - - Frank blood - -
  • Painless bleeding
  • Iron deficiency anemia
Normal Normal
Hemorrhoids - + - - Blood on tissues - +
  • Pain during defecation
  • Anemia
- Tortuoeus dilated vessels on anoscopy
Anal fissures - + - - Blood on tissues - +
  • Pain during defecation
  • Pain recurs with every bowel movement
Normal expect mild leucocytosis Anoscopy
Mesenteric Ischemia + - + + Frank blood + -
  • Pain alters with eating habits
  • Associated with other comorbid conditions
  • Leukocytosis
  • Increased hematocrit
  • High anion gap metabolic acidosis
  • Lactic acidosis
  • High phosphate levels
  • Mesenteric edema
  • Bowel dilatation
  • Bowel wall thickening
  • Intramural gas
  • Mesenteric stranding
Ischemic colitis + - - + + - 3 phases
  • Hyperactive Phase
  • Paralytic Phase(absent bowel sounds}
  • Shock Phase
  • Mild moderate diffuse bowel wall thickening
  • Marked hyperenhancement of the mucosa.
Crohn's disease + - + + + + Extra intestinal manifestations
  • :Uveitis
  • Sarcolitis
  • Anemia
  • Peripheral neuropathy
  • Skip lesions
  • Bowel wall thickening
  • Surrounding inflammation, abscess, and fistulae
Ulcerative colitis + + + + + +
Colon carcinoma + -† + + Occult bleeding + +† + FOBT

↑ CEA and CA 19-9

Hypercalcemia 

+Biopsy

Abbreviations: RUQ= Right upper quadrant of the abdomen, LUQ= Left upper quadrant, LLQ= Left lower quadrant, RLQ= Right lower quadrant, LFT= Liver function test, SIRS= Systemic inflammatory response syndrome, ERCP= Endoscopic retrograde cholangiopancreatography, IV= Intravenous, N= Normal, AMA= Anti mitochondrial antibodies, LDH= Lactate dehydrogenase, GI= Gastrointestinal, CXR= Chest X ray, IgA= Immunoglobulin A, IgG= Immunoglobulin G, IgM= Immunoglobulin M, CT= Computed tomography, PMN= Polymorphonuclear cells, ESR= Erythrocyte sedimentation rate, CRP= C-reactive protein, TS= Transferrin saturation, SF= Serum Ferritin, SMA= Superior mesenteric artery, SMV= Superior mesenteric vein, ECG= Electrocardiogram

Disease Clinical manifestations Diagnosis Comments
Symptoms Signs
Abdominal Pain Fever Rigors and chills Nausea or vomiting Jaundice Constipation Diarrhea Weight loss GI bleeding Hypo-

tension

Guarding Rebound Tenderness Bowel sounds Lab Findings Imaging
Acute diverticulitis LLQ + ± + + ± + Positive in perforated diverticulitis + + Hypoactive
  • CT scan
  • Ultrasound
Inflammatory bowel disease Diffuse ± ± + + + Normal or hyperactive

Extra intestinal findings:

Infective colitis Diffuse + ± + + Positive in fulminant colitis ± ± Hyperactive CT scan
  • Bowel wall thickening
  • Edema
Colon carcinoma Diffuse/localized ± ± + + ±
  • Normal or hyperactive if obstruction present
  • CBC
  • Carcinoembryonic antigen (CEA)
  • Colonoscopy
  • Flexible sigmoidoscopy
  • Barium enema
  • CT colonography 
  • PILLCAM 2: A colon capsule for CRC screening may be used in patients with an incomplete colonoscopy who lacks obstruction
Hemochromatosis RUQ Positive in cirrhotic patients N
  • >60% TS
  • >240 μg/L SF
  • Raised LFT
    Hyperglycemia
  • Ultrasound shows evidence of cirrhosis
Extra intestinal findings:
  • Hyperpigmentation
  • Diabetes mellitus
  • Arthralgia
  • Impotence in males
  • Cardiomyopathy
  • Atherosclerosis
  • Hypopituitarism
  • Hypothyroidism
  • Extrahepatic cancer
  • Prone to specific infections
Mesenteric ischemia Periumbilical Positive if bowel becomes gangrenous + + + + Positive if bowel becomes gangrenous Positive if bowel becomes gangrenous Hyperactive to absent CT angiography
  • SMA or SMV thrombosis
  • Also known as abdominal angina that worsens with eating
Acute ischemic colitis Diffuse + ± + + + + + + + Hyperactive then absent Abdominal x-ray
  • Distension and pneumatosis

CT scan

  • Double halo appearance, thumbprinting
  • Thickening of bowel
  • May lead to shock
Ruptured abdominal aortic aneurysm Diffuse ± + + + + N
  • Focused Assessment with Sonography in Trauma (FAST) 
  • Unstable hemodynamics
Intra-abdominal or retroperitoneal hemorrhage Diffuse ± ± + + N
  • ↓ Hb
  • ↓ Hct
  • CT scan

References

Template:WH Template:WS