Experiencing any type of bleeding can be uncomfortable and frightening for patients, and it is one of the primary reasons they seek medical attention. In this case presentation, I will discuss some crucial approaches to patients who present with lower gastrointestinal bleeding, as well as some key take-home messages.

1. LOWER GIT
BLEEDING
BY DR KEMI DELE-IJAGBULU
12/10/2023

2. CASE STUDY
24 year old female, para 1, NVD
Generally well
Known with peptic ulcer
Wel-controlled on omeprazole
Notices there is blood each time she wipes after
using the toilet (defecation).
No other complaint. Hb is 13 g/dl

3. REMEMBER TO IDENTIFY
THE SOURCE
When you see bright red blood per rectum, and
the client is healthy/stable, the source is very
close to the mouth of the anus — from the large
intestine.
The source may be: colon, rectum, or perianal

4. IDENTIFY THE SOURCE

5. POTENTIAL SOURCE
Sources Examples
Vascular
Haemorrhoids, Angiodysplasias,
Post-surgeries eg polypectomy
Inflammatory Inflammatory bowel disease, Colitis
Infection TB, Dysentery, Typhoid fever
Neoplasm Polyps, Cancers
Anatomic Diverticulitis, Anal fissures, Ulcers

6. GENERAL RULES
01
Bleeding from the colon (large intestine) is usually well-
mixed with stool. Eg, colitis,colonic cancer, diverticulitiez

7. GENERAL RULES
02
Bleeding from the upper GIT eg from (peptic ulcer) will first
travel via the small intestine, and the large intestine, by the
time it comes out, it is already altered, black and foul-
smelling (Melena stool). If there is a massive upper GIT
bleed, itthen comes out bright red

8. GENERAL RULES
03
Bright red blood on the toilet paper or blood dropping into
the toilet bowl after defeacation means that the origin is
closest to the outside — I.e. perianal/anorectal origin.
Eg haemorrhoids, anal fissures, rectal ulcers, analCa.
Thesepatients are generally stable and with normal vital
signs and Hb.

9. TREATMENT
Identify and treat the source.
If the patient is unstable, refer urgently to the
emergency department.
Most bleeding are self-limiting.
If the bleeding is ongoing, consider referral to the
rectal clinic (Livingstone hospital) for endoscopy.

10. Most lower GI bleeds are not major
They are also often self-limiting
The patients are usually stable, and the symptoms
are related to the cause
Always ask about their sexuality (MSM) and anal sex
If the bleeding is severe and the patient is
haemodynamically unstable, it is most likely a
massive upper GI bleed.
Take home

11. THANK
YOU!
Dr Kemi Dele-Ijagbulu