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History taking and physical examination for lower gastro intestinal bleed
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History taking and physical examination for lower gastro intestinal bleed

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  • 1. HISTORY TAKING AND PHYSICALEXAMINATION FOR LOWER GI BLEED
  • 2. HISTORY TAKINGOnset acute-ischaemia,meckel’s diverticulum,angiodysplasia Chronic-piles,IBD,Ca,polyps PILES
  • 3. AGE < 50 yrs- infection, anorectal disease, IBD > 50 yrs- malignancy, diverticulosis Any age- pilesDIVERTICULOSIS
  • 4. PAIN Painful-anorectal lesions, Ca anal canal, piles Painless- polyps, Meckel’s diverticulumPAIN IN RELATION TO DEFEACATION On defeacation- piles, Ca anal canal After defeacation- solitary rectal ulcer POLYPS
  • 5. TENESMUS rectal Ca, ulcerative proctitis, irradiation proctitisABDOMINAL PAIN AND BLOODY DIARRHEA IBD, infectious diarrhea, Ca colon
  • 6. NATURE OF BLOOD AND STOOLS Anorectal bleeding- straining and passing of hard stools, with dripping of blood Piles- blood may splash or drip after defeacation Ca anal canal and rectum- streaking of blood on stools MALIGNANCY
  • 7. COLOR OF STOOLS Brown stools streaked with blood- rectosigmoid or anal cause Large volume of bright red blood- colonic source Black stools- upper GI bleed Maroon stools- small intestine or right colon Bright red blood- anal canal
  • 8.  Bleeding from other sites- indicates systemic disease/ drug induced bleeding Weight loss, anorexia, abdominal pain, vomitting – malignancy Sexual abuse- trauma to anal canal
  • 9. PAST HISTORY Radiation Heart disease- mesenteric embolism Drugs- warfarin, heparin, NSAIDs Liver disease- variceal bleeding Chronic renal failure
  • 10. FAMILY HISTORY Carcinoma
  • 11. PERSONAL HISTORY Smoking- peptic ulceration, colorectal Ca alcohol
  • 12. CLINICAL EVALUATION history and physical examination are not usually diagnostic of the source of GI bleed Examine all system in detail with special reference to per rectum examination
  • 13. Patients with massive LGIB usually present with bright red blood per rectum hypotension markedly reduced hematocrit
  • 14. Patients with mild bleeding who may present with intermittent passage of maroon-colored stools.
  • 15. DIFFERENTIAL DIAGNOSISColonic bleeding( % Small bowel95%) bleeding(5%)Diverticular ds 30-40 Angiodysplasiaischaemia 5-10 UlcerAnorectal ds 5-15 Radiationneoplasia 5-10 neoplasiapolyp 3-7IBD 3-4angiodysplasia 3
  • 16. THANK YOU