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Lower GI Bleeding

Homepage: EMNote.org ■ 🚩Membership: https://tinyurl.com/joinemnote 🚩ACLS Lecture: https://tinyurl.com/emnoteacls Lower Gastrointestinal Bleeding LGI Bleeding Lower gastrointestinal bleeding occurs distal to the ligament of Treitz. Annual incidence is 109 cases per 100,000 individuals. Mortality rate is less than 1%. 80% of episodes resolve without intervention. Upper gastrointestinal bleeding can mimic LGIB. Key Definitions Hematochezia: Bright red or maroon rectal bleeding; suggests brisk bleeding. Melena: Black stools, often from an upper GI source or slow LGIB. Common Causes Diverticulosis: Painless bleeding, often resolves spontaneously. Vascular ectasia: Common with age, difficult to diagnose. Ischemic colitis: Most common intestinal ischemia, often transient. Mesenteric ischemia: Can cause bowel necrosis; challenging to diagnose. Meckel’s diverticulum: Ectopic gastric tissue causing mucosal erosion. Hemorrhoids: Common anorectal bleeding source, rarely severe. Diagnostic Approach History: Assess for bleeding type, associated symptoms, and medication use. Physical Exam: Check vitals, skin, abdomen, and rectum for abnormalities. Lab Tests: CBC, coagulation studies, BUN, and electrolytes. Imaging: Use selectively for perforation or obstruction. Management and Resuscitation Stabilize patients with oxygen, IV fluids, and cardiac monitoring. Correct coagulopathy if INR above 1.5 or platelets below 50,000/µL. Transfuse blood if hemoglobin falls below 7 g/dL or ongoing bleeding. Endoscopy and Surgery Flexible sigmoidoscopy assesses distal sources of bleeding. Colonoscopy identifies and treats bleeding with hemostatic techniques. Surgery is reserved for uncontrolled bleeding or endoscopic failure. Disposition Admit most patients for evaluation and management. ICU care for unstable or active bleeding patients. Outpatient management possible for mild bleeding with clear source.