Lower gastrointestinal bleeding resident survival guide

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

Definition

Lower GI bleed refers to any bleeding originating from gastrointestinal tract distal to ligament of Treitz.

• Acute GI bleed: Defined as bleeding occurring for less than 3 days.
• Chronic GI bleed: Defined as slow and intermittent bleeding occurring over a duration of several days.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. Any severe GI bleed can be life threatening and should be managed appropriately irrespective of the cause.

Common Causes

• Diverticulosis
• Colitis
• Angiodysplasia
• Colon cancer
• Radiation enteritis
• Inflammatory bowel disease
• Anorectal disorders

Management

Shown below is an algorithm summarizing the approach to [[disease name]].

Characterize the symptoms ❑ Frank blood per rectum (bleeding from left colon) ❑ Dark or maroon colored stools (bleeding from right colon) ❑ Abdominal pain ❑ Fatigue ❑ Diarrhea ❑ Constipation ❑ Fever ❑ Tenesmus ❑ Palpitations ❑ Lightheadedness Obtain past medical history: ❑ Previous GI bleed ❑ Use of NSAIDs, aspirin or anticoagulants ❑ History of radiation ❑ History of liver disease ❑ History of IBD ❑ Recent polypectomy ❑ Family history of colorectal cancer

Examine the patient ❑ Assess hemodynamic status ❑ Digital rectal examination ❑ Stool examination for occult blood

Hematochezia PLUS hemodynamic instability

Nasogastric lavage (to rule out UGIB)

Order tests ❑ CBC ❑ Coagulation profile ❑ Liver function tests ❑ Electrolytes ❑ BUN ❑ Creatinine ❑ EKG for elderly patients

References

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