Lower gastrointestinal bleeding history and symptoms
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Lower gastrointestinal bleeding Microchapters |
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Differentiating Lower gastrointestinal bleeding from other Diseases |
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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 clinical presentation of LGIB varies with the anatomic 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. Other symptoms of lower gastrointestinal bleeding include fever, abdominal pain, Bloody diarrhea, dehydration, hypotension in severe cases, and weight loss. A detailed description of the nature of the blood loss can help in pinpointing 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 enquired.
Past Surgical History
- A history of recent colonic polypectomy or biopsy indicates iatrogenic bleeding.
- This is usually low grade and limited, although it can be severe if an underlying artery is involved or if there is an inadequate coagulation of the polypectomy stalk.
- In 1.5% of polypectomies bleeding occurs immediately. However, delayed bleeding can occur several hours or days following the procedure.
Family history
- A family history of diseases such as IBD or colorectal malignancy should be considered.
Symptoms
- The clinical presentation of LGIB varies with the anatomic 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 presentation of LGIB can also vary depending on the etiology.
| Disease | Symptoms | |
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| Diverticular bleeding | Painless bleeding
Mild abdominal cramping If the bleeding is brisk and voluminous, patients may be hypotensive and display signs of shock | |
| Angiodysplasia | Painless, hematochezia or melena (slow but repeated bleeding episodes)
Syncope | |
| 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)
Insidious Patients presents with iron-deficiency anemia and syncope Whereas left-sided colonic neoplasms can present as bright red blood per rectum | |
| Hemorrhoids | Painless, whereas bleeding secondary to fissures tends to be painful.
Can also present with strangulation, hematochezia, and pruritus. | |