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HISTORY TAKING AND PHYSICAL
EXAMINATION FOR LOWER GI BLEED
HISTORY TAKING
Onset
 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- piles




DIVERTICULOSIS
PAIN
 Painful-anorectal lesions, Ca anal canal, piles

 Painless- polyps, Meckel’s diverticulum

PAIN IN RELATION TO DEFEACATION
 On defeacation- piles, Ca anal canal

 After defeacation- solitary rectal ulcer




            POLYPS
TENESMUS
 rectal Ca, ulcerative proctitis, irradiation proctitis



ABDOMINAL PAIN AND BLOODY DIARRHEA
 IBD, infectious diarrhea, Ca colon
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
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
 Bleeding from other sites- indicates systemic
  disease/ drug induced bleeding
 Weight loss, anorexia, abdominal pain, vomitting –
  malignancy
 Sexual abuse- trauma to anal canal
PAST HISTORY
 Radiation
 Heart disease- mesenteric embolism

 Drugs- warfarin, heparin, NSAIDs

 Liver disease- variceal bleeding

 Chronic renal failure
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 system in detail with special reference
 to per rectum examination
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 DIAGNOSIS
Colonic bleeding(       %   Small bowel
95%)                        bleeding(5%)
Diverticular ds     30-40   Angiodysplasia
ischaemia           5-10    Ulcer
Anorectal ds        5-15    Radiation
neoplasia           5-10    neoplasia
polyp               3-7
IBD                 3-4
angiodysplasia      3
THANK YOU

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History taking and physical examination for lower gastro intestinal bleed

  • 1. HISTORY TAKING AND PHYSICAL EXAMINATION FOR LOWER GI BLEED
  • 2. HISTORY TAKING Onset  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- piles DIVERTICULOSIS
  • 4. PAIN  Painful-anorectal lesions, Ca anal canal, piles  Painless- polyps, Meckel’s diverticulum PAIN IN RELATION TO DEFEACATION  On defeacation- piles, Ca anal canal  After defeacation- solitary rectal ulcer POLYPS
  • 5. TENESMUS  rectal Ca, ulcerative proctitis, irradiation proctitis ABDOMINAL 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 DIAGNOSIS Colonic bleeding( % Small bowel 95%) bleeding(5%) Diverticular ds 30-40 Angiodysplasia ischaemia 5-10 Ulcer Anorectal ds 5-15 Radiation neoplasia 5-10 neoplasia polyp 3-7 IBD 3-4 angiodysplasia 3