Lower gastrointestinal bleeding differential diagnosis

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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

Several diseases present with lower gastrointestinal bleeding and must be differented from each other. The common diseases responsible for lower GI bleeding inlcude diverticulosis, angiodysplasia, hemorrhoids, anal fissures, mesenteric Ischemia, ischemic colitis, inflammatory bowel disease, and colo-rectal carcinoma.

Differentiating Lower gastrointestinal bleeding from other Diseases

Several diseases present with lower gastrointestinal bleeding and must be differented from each other. The common diseases responsible for lower GI bleeding inlcude diverticulosis, angiodysplasia, hemorrhoids, anal fissures, mesenteric Ischemia, ischemic colitis, inflammatory bowel disease, and colo-rectal carcinoma.

Disease	Symptoms							Other features	Diagnosis
	Abdominal pain	Rectal pain	Weightloss	Fever	Type of GI bleeding	Diarrhea	Constipation		Laboratory findings	Radio-Imaging findings
Diverticulosis	-	-	-	-	Red or maroon-colored blood	-	+	Self limiting Seen in elderly	Normal	Globular outpouchings on CT scan
Angiodysplasia	-	-	-	-	Frank blood	-	-	Painless bleeding Iron deficiency anemia	Normal	Normal
Hemorrhoids	-	+	-	-	Blood on tissues	-	+	Pain during defecation Anemia	-	Tortuoeus dilated vessels on anoscopy
Anal fissures	-	+	-	-	Blood on tissues	-	+	Pain during defecation Pain recurs with every bowel movement	Normal expect mild leucocytosis	Anoscopy
Mesenteric Ischemia	+	-	+	+	Frank blood	+	-	Pain alters with eating habits Associated with other comorbid conditions	Leukocytosis Increased hematocrit High anion gap metabolic acidosis Lactic acidosis High phosphate levels	Mesenteric edema Bowel dilatation Bowel wall thickening Intramural gas Mesenteric stranding
Ischemic colitis	+	-	-	+		+	-	3 phases Hyperactive Phase Paralytic Phase(absent bowel sounds} Shock Phase	Elevated white blood cell count more than 15,000/mm3 in 20 patients (27%) The serum bicarbonate level was less than 24 mmol/L in 26 patients (36%)	Mild moderate diffuse bowel wall thickening Marked hyperenhancement of the mucosa.
Crohn's disease	+	-	+	+		+	+	Extra intestinal manifestations :Uveitis Sarcolitis Anemia Peripheral neuropathy	Anemia Leucocytosis Thrombocytosis + ASCA	Skip lesions Bowel wall thickening Surrounding inflammation, abscess, and fistulae
Ulcerative colitis	+	+	+	+		+	+	Joint swelling Joint pain Inflammation of the eye Skin involvement Fatty liver Thromboembolism Parenchymal lung disease	Anemia Thrombocytosis A high platelet count	Loss of the vascular appearance of the colon Erythema (or redness of the mucosa) and friability of the mucosa Superficial ulceration, which may be confluent Pseudopolyps
Colon carcinoma	+	-†	+	+	Occult bleeding	+	+†		+ FOBT ↑ CEA and CA 19-9 Hypercalcemia	+Biopsy