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 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, and hypotension in severe cases, and weight loss. A detailed description of the nature of the blood loss can also 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 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 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. | |
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.