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Lower GI
bleeding (Aetiology (Autoimmune
Small int: Crohn's, Coeliac…
Lower GI
bleeding
Aetiology
Autoimmune
Small int: Crohn's, Coeliac, vasculitis
Colon: IBD (Crohn's, UC)
Anorectal: fissures (IBD)
Degenerative
Colon: Meckel's diverticulum,
diverticular disease
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Vascular
Small int: angiodysplasia, bowel ischemia
Colon: angiodysplasia, bowel ischemia,
aorto-enteric fistula
Anorectal: haemorrhoids
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Pathophysiology
Acute lower GI usually present as
PR fresh blood, may have shock
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Diagnosis
Examination
Abdo
Cachexia, pallor, fever
Kolinychia, clubbing
abdominal mass, tenderness
PR
Haemorrhoids, fissueres
Fresh blood, malaena, PR mass
Investigations
Bloods
FBC (anaemia, WCC). CRP (infection/inflamm),
U+Es, LFTs, clotting
group and save, crossmatch
blood cultures (infection)
Immune screen (Coeliac, vasculitis)
Imaging
Erect CXR: bowel perforation
FAST scan: intra-abdominal bleed
Colonoscopy +/- biopsy
CT/MRI abdomen: IBD, Ca staging
Angiography: angiodysplasia
Bedside
Obs (shock, fever)
ECG (arrhythmia e.g. AF)
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History
PMH
IBD, Crohn's, diverticulae
Cancer
DH
NSAIDs, anticoagulants
Fe tablets (black stool)
PC/HPC
Amount, how often, type of stool
Fresh PR blood or malaena
Red flags e.g. fever, weight loss
SH
Smoking, alcohol, travel
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Definition
Bleeding from a site in the GIT
distal to the duodenum
(i.e. small bowel, colon, rectum)