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A lower gastrointestinal bleed is defined as bleeding originating distal to the ileocecal valve, which includes the colon, rectum, and anus. [2] LGIB was previously defined as any bleed that occurs distal to the ligament of Treitz, which included the aforementioned parts of the intestine and also included the last 1/4 of the duodenum and the entire area of the jejunum and ileum. [1]
Diverticular disease can present with painless rectal bleeding as bright red blood per rectum. Diverticular bleeding is the most common cause of acute lower gastrointestinal bleeding. [9] However, it is estimated that 80% of these cases are self-limiting and require no specific therapy. [10]
An upper GI bleed is more common than lower GI bleed. [2] An upper GI bleed occurs in 50 to 150 per 100,000 adults per year. [8] A lower GI bleed is estimated to occur in 20 to 30 per 100,000 per year. [2] It results in about 300,000 hospital admissions a year in the United States. [1] Risk of death from a GI bleed is between 5% and 30%.
Blood in stool looks different depending on how early it enters the digestive tract—and thus how much digestive action it has been exposed to—and how much there is. The term can refer either to melena, with a black appearance, typically originating from upper gastrointestinal bleeding; or to hematochezia, with a red color, typically originating from lower gastrointestinal bleeding. [6]
A complete blood count as well as an hemoglobin test should be performed when a patient presents symptoms of hematochezia. A colonoscopy may be necessary if there is suspicion of bleed from colon particularly in the elderly to look for the site and many causes of bleed like carcinoma, ulcerative colitis, rectal varices or other lesions and in certain instances upper gastrointestinal endoscopy ...
Rectal bleeding refers to bleeding in the rectum, thus a form of lower gastrointestinal bleeding. There are many causes of rectal hemorrhage, including inflamed hemorrhoids (which are dilated vessels in the perianal fat pads), rectal varices , proctitis (of various causes), stercoral ulcers , and infections .
Ischemic colitis must be differentiated from the many other causes of abdominal pain and rectal bleeding (for example, infection, inflammatory bowel disease, diverticulosis, or colon cancer). It is also important to differentiate ischemic colitis, which often resolves on its own, from the more immediately life-threatening condition of acute ...
The most common signs and symptoms are bleeding, which can vary from minor to severe, rectal prolapse and incomplete evacuation (35%-76% of cases). [4] According to one report, constipation is present in about 55% of cases, but diarrhea is present in 20%–40% of cases. [1] Reported symptoms are: Hematochezia (lower gastrointestinal bleeding).