Lower gastrointestinal bleeding
| Lower gastrointestinal bleeding | |
|---|---|
 |
|
| A positive fecal occult blood test | |
| Classification and external resources | |
| Specialty | gastroenterology |
| ICD-10 | K92.2 |
| ICD-9-CM | 578.9 |
| MedlinePlus | 003133 |
| eMedicine | radio/301 |
Lower gastrointestinal bleeding, commonly abbreviated LGIB, is any form of gastrointestinal bleeding in the lower gastrointestinal tract. LGIB is a common ailment seen at emergency departments. It presents less commonly than upper gastrointestinal bleeding (UGIB). It is estimated that UGIB accounts for 100–200 per 100,000 cases versus 20–27 per 100,000 cases for LGIB. Approximately 85% of lower gastrointestinal bleeding involves the colon, 10% are from bleeds that are actually upper gastrointestinal bleeds, and 3–5% involve the small intestines.
A lower gastrointestinal bleed is referred as any bleed that occurs distal to the ligament of Treitz and superior to the anus. This includes the last 1/4 of the duodenum and the entire area of the jejunum, ileum, colon, rectum, and anus.
The stool of a person with a lower gastrointestinal bleed is a good (but not infallible) indication of where the bleeding is occurring. Black tarry appearing stools medically referred to as melena usually indicates blood that has been in the GI tract for at least 8 hours. Melena is four-times more likely to come from an upper gastrointestinal bleed than from the lower GI tract; however, it can also occur in either the duodenum and jejunum, and occasionally the portions of the small intestine and proximal colon. Bright red stool, called , is the sign of a fast moving active GI bleed. The bright red or Maroon color is due to the short time taken from the site of the bleed and the exiting at the anus. The presence of hematochezia is six-times greater in a LGIB than with a UGIB.
Occasionally, a person with a LGIB will not present with any signs of internal bleeding, especially if there is a chronic bleed with ongoing low levels of blood loss. In these cases, a diagnostic assessment or pre-assessment should watch for other signs and symptoms that the patient may present with. These include, but are not limited to, hypotension, tachycardia, angina, syncope, weakness, confusion, stroke, myocardial infarction/heart attack, and shock.
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