Lower gastrointestinal bleeding history and symptoms

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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.
• 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 Abdominal pain Bloody diarrhea Dehydration Hypotension in severe cases Weight loss
	Infectious colitis
	Radiation-induced colitis
	Ulcerative colitis
Colon cancer		Right-sided bleeding (Maroon stools or melena) Weight loss Signs of iron-deficiency anemia Syncope Left-sided colonic neoplasms can present as bright red blood per rectum
Hemorrhoids		Painless (Bleeding secondary to fissures might be painful). Strangulation Hematochezia Pruritus