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
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.
- A young patient may present with fever, dehydration, abdominal cramps, and hematochezia caused by infectious or noninfectious (idiopathic) colitis.
- An older patient may present with painless bleeding and minimal symptoms caused by diverticular bleeding or angiodysplasia.
- LGIB can be mild and intermittent, as often is the case with angiodysplasia, or it may be moderate or severe, as may be the situation in diverticula-related bleeding.
- Young patients may present with abdominal pain, rectal bleeding, diarrhea, and mucous discharge that may be associated with IBD.
- Elderly patients presenting with abdominal pain, rectal bleeding, and diarrhea may have ischemic colitis.
- Elderly patients with atherosclerotic heart disease may present with intermittent LGIB and syncope that may be due to angiodysplastic lesions.
- Stools streaked with blood, perianal pain, and blood drops on the toilet paper or in the toilet bowl may be associated with perianal pathology, such as anal fissure or hemorrhoidal bleeding.
- The passage of maroon stools or bright red blood from the rectum is usually indicative of massive lower GI hemorrhage.
- Massive LGIB is a life-threatening condition in which patients present with a systolic blood pressure (SBP) of below 90 mm Hg and a hemoglobin (Hb) level of 6 g/dL or less.
| 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. | |