Lower gastrointestinal bleeding history and symptoms: Difference between revisions
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==Overview== | ==Overview== | ||
The hallmark symptom of LGIB is [[Rectal bleeding|bleeding per rectum]] or frank blood in stools. The presentation of associated symptoms depends upon the source of the bleeding and underlying etiology. Associated symptoms of lower gastrointestinal bleeding include [[fever]], [[abdominal pain]], [[bloody diarrhea]], [[dehydration]], history of [[constipation]], | The hallmark symptom of lower gastrointestinal bleeding (LGIB) is [[Rectal bleeding|bleeding per rectum]] or frank blood in stools. The presentation of associated symptoms depends upon the source of the bleeding and underlying etiology. Associated symptoms of lower gastrointestinal bleeding include [[fever]], [[abdominal pain]], [[bloody diarrhea]], [[dehydration]], history of [[constipation]], [[hypotension]] in severe cases, and [[weight loss]]. A detailed description of the nature of the [[blood loss]] can also help in finding the likely source of bleeding. | ||
==History== | ==History== | ||
A detailed description of the nature of the blood loss can help in pinpointing the likely source of bleeding. | A detailed description of the nature of the blood loss can help in pinpointing the likely source of bleeding. | ||
===Past Medical History=== | ===Past Medical History=== | ||
*History of recurrent bleeds suggests bleeding from angiodysplasia. | *History of recurrent bleeds suggests bleeding from [[angiodysplasia]]. | ||
*Associated weight loss suggests malignancy. | *Associated [[weight loss]] suggests [[malignancy]]. | ||
*Presence of systemic diseases such as atherosclerotic disease, IBD, coagulopathies, and HIV, and a history of pelvic irradiation for malignancy should be | *Presence of systemic diseases such as [[atherosclerotic disease]], [[IBD]], [[coagulopathies]], and [[HIV]], and a history of pelvic irradiation for malignancy should be inquired. | ||
===Past Surgical History=== | ===Past Surgical History=== | ||
*A history of recent colonic polypectomy or biopsy indicates iatrogenic bleeding | *A history of recent colonic [[polypectomy]] or biopsy indicates iatrogenic bleeding. | ||
===Family history=== | ===Family history=== | ||
*A family history of diseases such as IBD or colorectal malignancy should be considered. | *A family history of diseases such as [[IBD]] or [[Colorectal cancer|colorectal malignancy]] should be considered. | ||
==Symptoms== | ==Symptoms== | ||
*The most common presentation of LGIB is bleeding per rectum or frank blood in stools.<ref name="pmid21160742">{{cite journal |vauthors=Chait MM |title=Lower gastrointestinal bleeding in the elderly |journal=World J Gastrointest Endosc |volume=2 |issue=5 |pages=147–54 |year=2010 |pmid=21160742 |pmc=2998909 |doi=10.4253/wjge.v2.i5.147 |url=}}</ref><ref name="pmid23997409">{{cite journal |vauthors=Navuluri R, Kang L, Patel J, Van Ha T |title=Acute lower gastrointestinal bleeding |journal=Semin Intervent Radiol |volume=29 |issue=3 |pages=178–86 |year=2012 |pmid=23997409 |pmc=3577586 |doi=10.1055/s-0032-1326926 |url=}}</ref><ref name="pmid27016165">{{cite journal |vauthors=Qayed E, Dagar G, Nanchal RS |title=Lower Gastrointestinal Hemorrhage |journal=Crit Care Clin |volume=32 |issue=2 |pages=241–54 |year=2016 |pmid=27016165 |doi=10.1016/j.ccc.2015.12.004 |url=}}</ref> | *The most common presentation of LGIB is bleeding per [[rectum]] or frank blood in stools.<ref name="pmid21160742">{{cite journal |vauthors=Chait MM |title=Lower gastrointestinal bleeding in the elderly |journal=World J Gastrointest Endosc |volume=2 |issue=5 |pages=147–54 |year=2010 |pmid=21160742 |pmc=2998909 |doi=10.4253/wjge.v2.i5.147 |url=}}</ref><ref name="pmid23997409">{{cite journal |vauthors=Navuluri R, Kang L, Patel J, Van Ha T |title=Acute lower gastrointestinal bleeding |journal=Semin Intervent Radiol |volume=29 |issue=3 |pages=178–86 |year=2012 |pmid=23997409 |pmc=3577586 |doi=10.1055/s-0032-1326926 |url=}}</ref><ref name="pmid27016165">{{cite journal |vauthors=Qayed E, Dagar G, Nanchal RS |title=Lower Gastrointestinal Hemorrhage |journal=Crit Care Clin |volume=32 |issue=2 |pages=241–54 |year=2016 |pmid=27016165 |doi=10.1016/j.ccc.2015.12.004 |url=}}</ref> | ||
*The associated symptoms of LGIB varies with the underlying pathology and source of the bleeding. | *The associated symptoms of LGIB varies with the underlying pathology and source of the bleeding. | ||
*Commonly, LGIB from the right side of the colon can manifest as maroon stools, whereas a left-sided bleeding source may be evidenced by bright red blood per rectum. | *Commonly, LGIB from the right side of the colon can manifest as maroon stools, whereas a left-sided bleeding source may be evidenced by bright red blood per rectum. | ||
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!Symptoms | !Symptoms | ||
|- | |- | ||
| colspan="2" |Diverticular bleeding | | colspan="2" |[[Diverticular]] bleeding | ||
|Painless bleeding | |Painless bleeding | ||
Mild abdominal cramping | Mild [[Abdominal pain|abdominal cramping]] | ||
Signs of [[shock]] in cases of brisk and heavy bleeding. | |||
|- | |- | ||
| colspan="2" |Angiodysplasia | | colspan="2" |[[Angiodysplasia]] | ||
|Painless, hematochezia or melena | |Painless, [[hematochezia]] or [[melena]] | ||
Repeated bleeding episodes | |||
|- | |- | ||
| rowspan="4" |Colitis | | rowspan="4" |[[Colitis]] | ||
|Ischemic colitis | |[[Ischemic colitis]] | ||
| rowspan="4" |Fever | | rowspan="4" |[[Fever]] | ||
Abdominal pain | [[Abdominal pain]] | ||
Bloody diarrhea | [[Bloody diarrhea]] | ||
Dehydration | [[Dehydration]] | ||
Hypotension in severe cases | [[Hypotension]] in severe cases | ||
Weight loss | [[Weight loss]] | ||
|- | |- | ||
|Infectious colitis | |[[Infectious colitis]] | ||
|- | |- | ||
|Radiation-induced colitis | |Radiation-induced colitis | ||
|- | |- | ||
|Ulcerative colitis | |[[Ulcerative colitis]] | ||
|- | |- | ||
| colspan="2" |Colon cancer | | colspan="2" |[[Colon cancer]] | ||
|Right-sided bleeding (Maroon stools or melena) | |Right-sided bleeding (Maroon stools or melena) | ||
[[Weight loss]] | |||
Signs of [[Iron deficiency anemia|iron-deficiency anemia]] | |||
[[Syncope]] | |||
Left-sided colonic [[neoplasms]] can present as bright red blood per rectum | |||
|- | |- | ||
| colspan="2" |Hemorrhoids | | colspan="2" |Hemorrhoids | ||
|Painless | |Painless | ||
(Bleeding secondary to [[fissures]] might be painful) | |||
[[Hematochezia]] | |||
[[Pruritus]] | |||
|} | |} | ||
Latest revision as of 17:54, 29 December 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]
Overview
The hallmark symptom of lower gastrointestinal bleeding (LGIB) is bleeding per rectum or frank blood in stools. The presentation of associated symptoms depends upon the source of the bleeding and underlying etiology. Associated symptoms of lower gastrointestinal bleeding include fever, abdominal pain, bloody diarrhea, dehydration, history of constipation, hypotension in severe cases, and weight loss. A detailed description of the nature of the blood loss can also help in finding the likely source of bleeding.
History
A detailed description of the nature of the blood loss can help in pinpointing the likely source of bleeding.
Past Medical History
- History of recurrent bleeds suggests bleeding from angiodysplasia.
- Associated weight loss suggests malignancy.
- Presence of systemic diseases such as atherosclerotic disease, IBD, coagulopathies, and HIV, and a history of pelvic irradiation for malignancy should be inquired.
Past Surgical History
- A history of recent colonic polypectomy or biopsy indicates iatrogenic bleeding.
Family history
- A family history of diseases such as IBD or colorectal malignancy should be considered.
Symptoms
- The most common presentation of LGIB is bleeding per rectum or frank blood in stools.[1][2][3]
- The associated symptoms of LGIB varies with the underlying pathology and source of the bleeding.
- Commonly, LGIB from the right side of the colon can manifest as maroon stools, whereas a left-sided bleeding source may be evidenced by bright red blood per rectum.
- The following table summarizes the various associated symptoms of LGIB depending on the etiology.
| Disease | Symptoms | |
|---|---|---|
| Diverticular bleeding | Painless bleeding
Mild abdominal cramping Signs of shock in cases of brisk and heavy bleeding. | |
| Angiodysplasia | Painless, hematochezia or melena
Repeated bleeding episodes | |
| Colitis | Ischemic colitis | Fever
Hypotension in severe cases |
| Infectious colitis | ||
| Radiation-induced colitis | ||
| Ulcerative colitis | ||
| Colon cancer | Right-sided bleeding (Maroon stools or melena)
Signs of iron-deficiency anemia Left-sided colonic neoplasms can present as bright red blood per rectum | |
| Hemorrhoids | Painless
(Bleeding secondary to fissures might be painful) | |
References
- ↑ Chait MM (2010). "Lower gastrointestinal bleeding in the elderly". World J Gastrointest Endosc. 2 (5): 147–54. doi:10.4253/wjge.v2.i5.147. PMC 2998909. PMID 21160742.
- ↑ Navuluri R, Kang L, Patel J, Van Ha T (2012). "Acute lower gastrointestinal bleeding". Semin Intervent Radiol. 29 (3): 178–86. doi:10.1055/s-0032-1326926. PMC 3577586. PMID 23997409.
- ↑ Qayed E, Dagar G, Nanchal RS (2016). "Lower Gastrointestinal Hemorrhage". Crit Care Clin. 32 (2): 241–54. doi:10.1016/j.ccc.2015.12.004. PMID 27016165.