BGIT
LGIT
Based on Ligament of Treitz / duodenojejunal flexure
Colon
Anorectal
Anus
Colitis
Inflammatory (IBD)
UC (usually from caecum down)
Epidem: Usually Indians or Malay
Mucoids, bloody diarrhoea
Autoimmune disease - T1DM, thyroid diseases, vitiligo
Malignancy
Diverticular bleed
Diverticulosis (just outpouching)
Diverticulitis (inflammation)
Haemorrhoids
Internal
External
External more pain
Reducible or non-reducible
Blood coats stools
Malignancy
AVM
Anal fissure
Ask hx to check location
Blood in stool -> fresh blood? Mixed with stools?
Anal sex?
Pencil-thin stools - usually anus area rather than rectum
Abdominal pain (~44%)
Constitutional symptoms
Haematochezia vs melena
Any symptomatic anaemia? (usually chronic microcytic anaemia rather than massive blood loss)
Any risk factors?
UGIT
Non-variceal
Variceal
Stomach
Oesophagus
CA
Esophageal cancer
Malignancy Ix for GS:
- OGD (to confirm diagnosis)
- TNM staging (endoscopic US, chest, abdo pelvis CT, laproscopy)
- FBC, renal panal (for electrolyte imbalance), LFT (albumin is a nutritional marker, ALP is elevated in malignancy)
Hx of H.pylori
Hx of triple therapy
Med/Drug hx:
- NSAIDs
- TCM (usually steroids)
PUD
Boerhaave
Mallory-Weiss
CA stomach
CA cardia
Red flags for change in bowel habits:
Alternating constipation and diarrhoea
Spurious diarrhoea
Pencil-thin stools
Tenesmus (feeling of defecation + pain)
Crohn's (skip lesions)
Infective
Chemical
Ischemic
Angiodysplasia
Usually blood + mucus
Extraintestinal manifestations (A PIE SAC)
Painless haematochezia (maroon or bright red)
If +ve: Check for mets complications
Systemic
Coagulopathy
Severe sharp pain
Complications
- Symptoms of dehydration and shock
- Symptoms of anaemia