3. Definition
● Lower GI - bleeding is
defined as abnormal
hemorrhage into the
lumen of the bowel from a
source distal to the
ligament of Treitz.
● Normal faecal blood loss –
1.2 ml / day
● Significant - > 10 ml / day
4.
5. Presentation
● Lower GI bleeding typically presents with
1. Hematochezia (which can range from bright-red blood to old clots)
2. Melena (If the bleeding is slower or from a more proximal source)
6.
7.
8. Massive Bleeding
● Presents as a large volume of
bright red blood PR
● Bleeding > 1.5 l / day
● Hemodynamic instability & shock
● ↓ in hematocrit level of 6 g / dL
● Common causes – D / A
● Transfusion of at least 2 units of
packed red blood cells
● Bleeding that continues for 3 days
Moderate Bleeding
● Presents as haematochezia
or malena
● Hemodynamically stable
● Causes – Ano-rectal / Cong./
Infla.& Neoplastic diseases
● Initial ↓ in hematocrit level
of 8 g / dL or less
9. Occult Blood
● Detected by routine chemical
tests of the stool, with or
without systemic evidence of
chronic blood loss.
● 10 ml. of blood loss / day is
necessary to have stool
occult blood positive.
14. With Pain
● Fissure in Ano
● Fistula in Ano
● Ca. Anal Canal
● Rup. perianal haematoma
● Rup. Ano Rectal abscess
● Endometriosis
● Injury
15. Without Pain
1. Blood Alone
a. Polyp
b. Villous Adenoma
c. Diverticular diseases
2. Blood After Defecation
a. Hemorrhoids
3. Blood with mucus
a. Ulcerative colitis
b. Intussusception
c. Ischaemic Colon
4. Blood Streaked on stool
a. Ca. Rectum
21. Clinical Presentations
Bleeding Per rectum –
-
-
-
-
-
-
-
Bright red blood
Altered blood
Maroon colour
Streaks of blood
Splash in pan
Red currant jelly
Blood with mucus
Piles / Polyps / Fissure
Ca / Ulcer / IBD / Dysentery
Meckel’s diverticulum
Anal fissure
Piles
Intussusception
Colitis / Ca / Dysentery
Note : Ask & Look for bleeding tendency
22.
23.
24.
25. Relation to Defecation
● Streak of fresh blood – FIA
● At the time of passing stool –
Bright red & Splashes over the pan
- Piles
● Other than during defecation -
Polyps / Ca / UC
● Bleeding per anum in child –
Polyp
26. OTHERS
● Pain
● Altered bowel habits
● Anaemia / Malnutrition / LOW / LOA
● Mass palpable PA – Rt /Lt / MOI
● Per-rectal exam – Very important
27. Investigations
1. Blood Tests –
a. Hb% / PCV / LFT
b. Coag. Profile / RFT
2. Stool examination -
a. Ova / cyst / worms
b. Occult blood – FOBT
