Lower Gastrointestinal Bleeding (LGIB)

Notes
  • LGIB is defined as bleeding that occurs from a source distal to the ligament of Treitz (which is between the duodenum and jejunum).
  • Causes include:

_Diverticulitis

_Hemmorrhoids

_Anal Fistula or fissure

_Ischemic colitis

_Trauma

_Drugs such as warfarin and excessive alcohol intake

_Bleeding disorders (mainly congenital)

_Angiodysplasia (bleeding caused by continuous thining of blood vessel that line the GIT that result in their bursting).

_Malignancies especially colon cancer

_Infectious diarrhea by schistosoma, amoeba, shigella etc.

_Intussusception (that is bowel obstruction)

_Inflammatory Bowel Disease

_Polyps

Symptoms
  • Melena (when blood has been digested in the GIT)
  • Maroon stool
  • Fecal occult blood (FOB)
  • Bright red blood in stool (brisk bleeding or hematochezia)
Diagnosis
  • History and physical examination
  • Endoscopy that include colonoscopy, proctoscopy, sigmoidoscopy and biopsy
  • ESR
  • Stool microscopy and Culture & Sensitivity
  • Barium meal (after the patient is stable)
  • Full Blood Count (FBC) -any anemia??
  • ECG – any cardiac disorder?
  • Partial thromboplastin time (PTT) or thromboplastin time (PT)
  • Platelet count
  • Blood cross-matching in readiness for possible transfusion
  • Tagged RBC Scan
  • Capsule endoscopy
Management
  • Infusion with normal saline to maintain vital functions such as blood pressure and purse rates.
  • IV Octreotide (especially in the presence of hematemesis and history of liver disease or alcoholism). It is a powerful vasoconstrictor
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