HISTORY TAKING AND PHYSICALEXAMINATION FOR LOWER GI BLEED
HISTORY TAKINGOnset acute-ischaemia,meckel’s  diverticulum,angiodysplasia Chronic-piles,IBD,Ca,polyps          PILES
AGE < 50 yrs- infection, anorectal disease, IBD > 50 yrs- malignancy, diverticulosis Any age- pilesDIVERTICULOSIS
PAIN Painful-anorectal lesions, Ca anal canal, piles Painless- polyps, Meckel’s diverticulumPAIN IN RELATION TO DEFEACAT...
TENESMUS rectal Ca, ulcerative proctitis, irradiation proctitisABDOMINAL PAIN AND BLOODY DIARRHEA IBD, infectious diarrh...
NATURE OF BLOOD AND STOOLS Anorectal bleeding- straining and passing of hard  stools, with dripping of blood Piles- bloo...
COLOR OF STOOLS Brown stools streaked with blood- rectosigmoid or  anal cause Large volume of bright red blood- colonic ...
 Bleeding from other sites- indicates systemic  disease/ drug induced bleeding Weight loss, anorexia, abdominal pain, vo...
PAST HISTORY Radiation Heart disease- mesenteric embolism Drugs- warfarin, heparin, NSAIDs Liver disease- variceal ble...
FAMILY HISTORY   Carcinoma
PERSONAL HISTORY Smoking- peptic ulceration, colorectal Ca alcohol
CLINICAL EVALUATION history and physical examination are not usually diagnostic of the source of GI bleed  Examine all sys...
Patients with massive LGIB usually present with bright red blood per rectum hypotension markedly reduced hematocrit
Patients with mild bleeding who may present with intermittent passage of maroon-colored stools.
DIFFERENTIAL DIAGNOSISColonic bleeding(       %   Small bowel95%)                        bleeding(5%)Diverticular ds     3...
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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

  1. 1. HISTORY TAKING AND PHYSICALEXAMINATION FOR LOWER GI BLEED
  2. 2. HISTORY TAKINGOnset acute-ischaemia,meckel’s diverticulum,angiodysplasia Chronic-piles,IBD,Ca,polyps PILES
  3. 3. AGE < 50 yrs- infection, anorectal disease, IBD > 50 yrs- malignancy, diverticulosis Any age- pilesDIVERTICULOSIS
  4. 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. 5. TENESMUS rectal Ca, ulcerative proctitis, irradiation proctitisABDOMINAL PAIN AND BLOODY DIARRHEA IBD, infectious diarrhea, Ca colon
  6. 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. 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. 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. 9. PAST HISTORY Radiation Heart disease- mesenteric embolism Drugs- warfarin, heparin, NSAIDs Liver disease- variceal bleeding Chronic renal failure
  10. 10. FAMILY HISTORY Carcinoma
  11. 11. PERSONAL HISTORY Smoking- peptic ulceration, colorectal Ca alcohol
  12. 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. 13. Patients with massive LGIB usually present with bright red blood per rectum hypotension markedly reduced hematocrit
  14. 14. Patients with mild bleeding who may present with intermittent passage of maroon-colored stools.
  15. 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
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