Lower Gastrointestinal Bleeding Questions & Answers

Updated: Jul 26, 2019
  • Author: Burt Cagir, MD, FACS; Chief Editor: BS Anand, MD  more...
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Questions & Answers

Overview

What is lower gastrointestinal (GI) bleeding (LGIB)?

What are the possible clinical presentations of lower gastrointestinal (GI) bleeding (LGIB)?

What is the presentation of lower gastrointestinal (GI) bleeding (LGIB) caused by colitis?

What are causes lower gastrointestinal (GI) bleeding (LGIB)?

What is the manifestation of massive lower gastrointestinal (GI) bleeding (LGIB) in patients aged 65 and older?

Which procedures are used to diagnose lower gastrointestinal (GI) bleeding (LGIB)?

What is the role of routine blood tests for diagnosing lower gastrointestinal (GI) bleeding?

What criteria are used for establishing the bleeding site of lower gastrointestinal (GI) bleeding (LGIB)?

What procedures are performed following multiple episodes of lower gastrointestinal (GI) bleeding (LGIB) with no identified source?

What are the three components of management of lower gastrointestinal (GI) bleeding (LGIB)?

What is the initial assessment of lower gastrointestinal (GI) bleeding (LGIB)?

What are the nonsurgical options for lower gastrointestinal (GI) bleeding (LGIB)?

When is surgery indicated for treatment of lower gastrointestinal (GI) bleeding (LGIB)?

How common is lower gastrointestinal (GI) bleeding (LGIB)?

How is acute lower gastrointestinal (GI) bleeding (LGIB) defined?

How is lower gastrointestinal (GI) bleeding (LGIB) classified?

How is massive lower gastrointestinal (GI) bleeding (LGIB) defined?

What is the mortality rate and risk factors for lower gastrointestinal (GI) bleeding (LGIB)?

Which interventions have reduced the need for surgery in lower GI bleeding (LGIB)?

How did the pathogenesis, diagnosis, and treatment of lower GI bleeding (LGIB) evolve over the 20th century?

What are key points in the diagnosis and management of lower GI bleeding?

What knowledge is essential for performing a primary lower GI procedure for bleeding?

What is the anatomy of arteries in the lower GI region?

What conditions may cause lower GI bleeding (LGIB)?

What is the role of diverticulosis in the pathophysiology of lower GI bleeding (LGIB)?

What role does angiodysplasia play in the pathophysiology of lower GI bleeding (LGIB)?

What roles does colitis play in the pathophysiology of lower GI bleeding (LGIB)?

What is the role of colorectal carcinoma in lower GI bleeding (LGIB)?

What is the role of benign anorectal disease in lower GI bleeding (LGIB)?

What causes lower GI bleeding (LGIB)?

What are common causes of lower GI bleeding (LGIB)?

What are the common causes of lower gastrointestinal (GI) bleeding (LGIB) in children?

What is the most common reason for massive lower gastrointestinal (GI) bleeding (LGIB)?

What is the role of angiodysplasia in the etiology of lower gastrointestinal (GI) bleeding (LGIB)?

What is the role of ischemic colitis in the etiology of lower gastrointestinal (GI) bleeding?

Which infectious agents may cause lower gastrointestinal (GI) bleeding (LGIB)?

What is the role of IBD in the etiology of lower gastrointestinal (GI) bleeding (LGIB)?

What is the incidence of lower gastrointestinal (GI) neoplastic bleeding?

Which anorectal conditions cause lower gastrointestinal (GI) bleeding?

What are less common causes of lower gastrointestinal (GI) bleeding (LGIB)?

How does the incidence of lower gastrointestinal (GI) bleeding vary by sex?

What is the prevalence of massive lower gastrointestinal (GI) bleeding?

What percentage of significant lower gastrointestinal (GI) bleeding is caused by diverticulosis?

What is the prognosis of lower gastrointestinal (GI) bleeding?

How have advances in imaging improved the prognosis of lower gastrointestinal (GI) bleeding?

Presentation

What should be the focus of medical history in the evaluation of lower gastrointestinal (GI) bleeding?

How does the clinical presentation of lower gastrointestinal (GI) bleeding vary with anatomic source and etiology?

What are the signs and symptoms of lower gastrointestinal (GI) bleeding (LGIB)?

What are the signs and symptoms of massive lower gastrointestinal (GI) bleeding (LGIB)?

What are the signs and symptoms diverticular-related lower gastrointestinal (GI) bleeding (LGIB)?

What are the signs and symptoms of angiodysplasia-related lower gastrointestinal (GI) bleeding (LGIB)?

What are the signs and symptoms of colitis-related lower gastrointestinal (GI) bleeding (LGIB)?

What are the signs and symptoms of colon carcinoma caused lower gastrointestinal (GI) bleeding (LGIB)?

What are the signs and symptoms of lower gastrointestinal (GI) bleeding (LGIB) caused by hemorrhoids?

What should be included in the physical exam for lower gastrointestinal (GI) bleeding (LGIB)?

Why should an anorectal exam be done early in the evaluation of lower gastrointestinal (GI) bleeding (LGIB)?

What should be done to reduce morbidity and mortality once the source of lower gastrointestinal (GI) bleeding (LGIB) has been determined?

DDX

What is the prevalence of lower gastrointestinal (GI) bleeding (LGIB) of unknown etiology?

What rare causes of lower gastrointestinal (GI) bleeding (LGIB) should be considered in the differential diagnoses?

What are the differential diagnoses for Lower Gastrointestinal Bleeding?

Workup

What is the role of blood tests in the diagnosis of lower gastrointestinal (GI) bleeding (LGIB)?

Which endoscopic procedures are performed in the evaluation of lower gastrointestinal (GI) bleeding?

How should multiple episodes of lower gastrointestinal (GI) be evaluated?

What is the role of barium enema testing in the evaluation of lower gastrointestinal (GI) bleeding (LGIB)?

What is the role of provocative bleeding studies in the diagnosis of occult lower gastrointestinal (GI) bleeding?

How is CT scanning used to differentiate intestinal ischemia from intramural hemorrhage in lower gastrointestinal (GI) bleeding (LGIB)?

When is helical CT scanning used to determine the cause of lower gastrointestinal (GI) bleeding (LGIB)?

How is three-phase helical CT scanning performed in the evaluation of lower gastrointestinal (GI) bleeding (LGIB)?

What is the role of multidetector row CT (MDCT) scanning in the evaluation of lower gastrointestinal (GI) bleeding (LGIB)?

What is the role of CTA in the evaluation of lower gastrointestinal (GI) bleeding?

What are the benefits of CTA) for the diagnosis of lower gastrointestinal (GI) bleeding (LGIB)?

What is the initial diagnostic study of choice for lower gastrointestinal (GI) bleeding (LGIB)?

How is colonoscopy utilized in the diagnosis of lower gastrointestinal (GI) bleeding (LGIB)?

What is the role of early colonoscopy in the evaluation of lower gastrointestinal (GI) bleeding (LGIB)?

What is the role of urgent colonoscopy in the diagnosis of lower gastrointestinal (GI) bleeding (LGIB)?

When is emergent colonoscopy indicated in lower gastrointestinal (GI) bleeding (LGIB)?

Which patients are candidates for urgent colonoscopy to evaluate lower gastrointestinal (GI) bleeding (LGIB)?

Which imaging study should be performed prior to colonoscopy for lower gastrointestinal (GI) bleeding (LGIB)?

When should upper endoscopy be performed in the evaluation of lower gastrointestinal (GI) bleeding (LGIB)?

What are benefits of colonoscopy in the evaluation of lower gastrointestinal (GI) bleeding (LGIB)?

What are possible limitations of colonoscopy in the evaluation of lower gastrointestinal (GI) bleeding LGIB)?

What role does radionuclide scanning play in the diagnosis and treatment of lower gastrointestinal (GI) bleeding (LGIB)?

How sensitive is radionuclide scanning in the diagnosis of lower gastrointestinal (GI) bleeding (LGIB)?

Why are radionuclide scans performed before angiography in the workup of lower gastrointestinal (GI) bleeding (LGIB)?

What is the accuracy TRBC scintigraphy in identifying site of severe lower gastrointestinal (GI) bleeding (LGIB)?

Why TRBC scintigraphy the preferred modality for detecting lower gastrointestinal (GI) bleeding (LGIB)?

What is the role of Tc sulfur colloid scans in the evaluation of lower gastrointestinal (GI) bleeding (LGIB)?

What is the role of In-labeled red blood cell (RBC) scintigraphy for evaluation of lower gastrointestinal (GI) bleeding (LGIB)?

What are the limitations of radionuclide scanning for evaluation of lower gastrointestinal (GI) bleeding (LGIB)?

What is the role of angiography in the workup of lower gastrointestinal (GI) bleeding (LGIB)?

When diagnosing lower gastrointestinal (GI) bleeding (LGIB), what can be visualized on angiography?

When is emergency angiography indicated in the workup of lower gastrointestinal (GI) bleeding (LGIB)?

What are the advantages and disadvantages of angiography for diagnosing lower gastrointestinal (GI) bleeding (LGIB)?

What is the role of esophagogastroduodenoscopy (EGD) in the workup of lower gastrointestinal (GI) bleeding (LGIB)?

How is the small bowel visualized in the diagnosis and treatment of lower gastrointestinal (GI) bleeding (LGIB)?

What are the advantages and disadvantages of wireless capsule endoscopy (WCE) in the evaluation of lower gastrointestinal (GI) bleeding (LGIB)?

What are the advantages and disadvantages of enteroscopy for evaluation of lower gastrointestinal (GI) bleeding (LGIB)?

When is enteroclysis contraindicated in the evaluation of lower gastrointestinal (GI) bleeding (LGIB)?

Which histologic findings suggest the etiology in lower gastrointestinal (GI) bleeding (LGIB)?

Treatment

When is admission to the ICU indicated for lower gastrointestinal (GI) bleeding (LGIB)?

What are the components of lower gastrointestinal (GI) bleeding (LGIB) management?

Which advances have resulted in improved patient outcomes and reduced healthcare costs for lower gastrointestinal (GI) bleeding (LGIB)?

What is the basis for sequencing of treatment modalities for lower gastrointestinal (GI) bleeding (LGIB)?

What is the treatment for massive lower gastrointestinal (GI) bleeding (LGIB)?

What are the AAFP guidelines for recommendations for the initial evaluation and management of lower gastrointestinal (GI) bleeding (LGIB)?

How is initial resuscitation performed for lower gastrointestinal (GI) bleeding (LGIB)?

When is fluid volume replacement therapy indicated for lower gastrointestinal (GI) bleeding (LGIB)?

What are the signs of hemodynamic compromise in lower gastrointestinal (GI) bleeding (LGIB)?

When is transfusions indicated in the treatment of lower gastrointestinal (GI) bleeding (LGIB)?

When is admission to the ICU indicated for lower gastrointestinal (GI) bleeding (LGIB)?

How is the lower gastrointestinal (GI) bleeding site localized?

What is the role of endoscopic hemostasis therapy in the management of lower gastrointestinal (GI) bleeding (LGIB)?

What is the indication for therapeutic colonoscopy for lower gastrointestinal (GI) bleeding (LGIB)?

What is the indication for vasoconstrictive therapy for lower gastrointestinal (GI) bleeding (LGIB)?

What are possible complications of vasoconstrictive therapy for lower gastrointestinal (GI) bleeding (LGIB)?

What is the role of superselective embolization in the treatment of lower gastrointestinal (GI) bleeding (LGIB)?

What is the efficacy of superselective embolization in the treatment of lower gastrointestinal (GI) bleeding (LGIB)?

What are the possible complications of superselective embolization for the treatment of lower gastrointestinal (GI) bleeding (LGIB)?

What are the AAFP guidelines for endoscopic hemostasis therapy for lower gastrointestinal (GI) bleeding (LGIB)?

What is the role of sclerotherapy in the treatment of lower gastrointestinal (GI) bleeding (LGIB)?

What are the advantages of an endoscopic epinephrine injection for the treatment of lower gastrointestinal (GI) bleeding (LGIB)?

What is the role of endoscopic thermal modalities for the treatment of lower gastrointestinal (GI) bleeding (LGIB)?

What is the efficacy of endoscopic treatment for lower gastrointestinal (GI) bleeding (LGIB)?

What is the treatment of choice for angiodysplasias-related lower gastrointestinal (GI) bleeding (LGIB)?

What is the indication for emergent surgery for lower gastrointestinal (GI) bleeding (LGIB)?

When is surgery indicated for treatment of lower gastrointestinal (GI) bleeding?

What is the role of segmental bowel resection in the treatment of lower gastrointestinal (GI) bleeding?

Which procedures may be helpful in detecting undiagnosed massive gastrointestinal (GI) bleeding?

What is the recommended treatment for active lower gastrointestinal (GI) bleeding?

What is the role of segmental colectomy in the treatment of lower gastrointestinal (GI) bleeding (LGIB)?

What are the morbidity rates of surgery for the treatment of lower gastrointestinal (GI) bleeding?

What is the role of blind segmental resection for the treatment of lower gastrointestinal (GI) bleeding (LGIB)?

What are the preoperative details of surgical resection for lower gastrointestinal (GI) bleeding?

What are the intraoperative details of surgical resection for lower gastrointestinal (GI) bleeding?

What are possible complications of shock following surgical resection for lower gastrointestinal (GI) bleeding?

What are complications of blood transfusions in lower gastrointestinal (GI) bleeding?

What are common early post-operative complications of lower gastrointestinal (GI) bleeding surgery?

What causes sepsis following colorectal surgery for lower gastrointestinal (GI) bleeding and how is it treated?

When do delayed complications usually occur after surgery for lower gastrointestinal (GI) bleeding?

What is the efficacy of transfusion-free management of lower gastrointestinal (GI) bleeding?

What long-term monitoring is needed following surgery for lower gastrointestinal (GI) bleeding?

Medications

What is the efficacy of vasoconstrictive agents for the treatment of lower gastrointestinal (GI) bleeding?

How is lower gastrointestinal (GI) bleeding managed in patients on anticoagulant therapy?

Which agents should be avoided in patients with a history of acute lower gastrointestinal (GI) bleeding?

Which medications in the drug class Adrenergic Agonists are used in the treatment of Lower Gastrointestinal Bleeding?

Which medications in the drug class Posterior Pituitary Hormones are used in the treatment of Lower Gastrointestinal Bleeding?