This article discusses the presentation, diagnosis, and management of LGIB with a focus on conditions that present with acute blood loss. Copyright © 2016 Elsevier Inc. All rights reserved. [ncbi.nlm.nih.gov]

Patient We report a case of an adult in his 5th decade presenting with massive melena. Interventions On presentation the patient was tachycardic (pulse115/min), and hypotensive (BP 80/55 mmHg). His complete physical examination was unremarkable. [doi.org]

• Supraclavicular Adenopathy

  adenopathy; palpable mass; abdominal pain; weight loss; cachexia Lower GI tract Diverticular disease Age > 60 years; painless bleeding; possible recent constipation Arteriovenous malformations Age > 60 years; painless bleeding; chronic renal failure [aafp.org]

• Mucosal Edema

  Colonoscopy reveals bowel mucosal edema, erythema, friability, and ulceration. Colitis can be categorized as infectious, ischemic, or inflammatory in nature. [ahcmedia.com]

• Maroon Stools

  Maroon stools are maroon-colored blood mixed with stool that is often associated with a right colonic source of bleeding; however, it can also result from a more brisk, proximal source of bleeding. [accessmedicine.mhmedical.com]

  stools (16.7%) and melena (11%). [emedicine.medscape.com]

• Sister Mary Joseph's Nodule

  Physical examination findings might include a palpable tumor mass, a Sister Mary Joseph nodule of the umbilicus (a metastatic umbilical mass due to an intra-abdominal neoplasm), or left supraclavicular lymphadenopathy. [ahcmedia.com]

• Perianal Lump

  External hemorrhoids are usually painless until they become thrombosed, at which time they cause a painful palpable perianal lump. [ahcmedia.com]

• Right Lower Quadrant Tenderness

  He progressed to develop abdominal distension, vomiting, and significant right lower quadrant tenderness during the next 2 days. [jamanetwork.com]

• Rectal Tenderness

  Physical examination was notable for no subjective or objective findings of orthostatic hypotension; increased bowel sounds and diffuse mild abdominal tenderness; and no external hemorrhoids, fissures, or rectal tenderness. [mdedge.com]

• Hypotension

  The patient re-presented to the emergency room with recurrent bleeding, anemia, and hypotension. During a period of active bleeding, a number of diagnostic studies ultimately revealed the source to be the proximal jejunum. [ncbi.nlm.nih.gov]

  Tachycardia and Orthostatic Hypotension. There have been discussions in the literature about other findings to rule in/out upper GI bleeding. [mdedge.com]

  View larger version (225K) Fig. 3C —85-year-old man who presented with rectal bleeding, hypotension, and tachycardia. C, Angiogram obtained after A and B shows localized bleeding (arrow) in duodenum. [ajronline.org]

Etiology Although lower GI bleeding can occur at any age, specific disease processes are distinctive for different age groups and familiarity with this can help tailor the diagnostic workup 2,6: adolescents and young adults inflammatory bowel disease [radiopaedia.org]

Laboratory workup reveals that the patient is anemic. Fecal occult blood test is positive for bleeding. EGD was performed and did not reveal upper GI bleeding. [medbullets.com]

Interestingly a colonoscopy done 6 months earlier for anemia workup was normal. Emergent laparotomy revealed numerous smaller intraluminal nodules scattered throughout the small bowel. Results Histopathology revealed carcinoid tumor. [doi.org]

(PT), platelet count, and/or bleeding time (bleeding time is only recommended in patients with bleeding disorders and in those using antiplatelet agents) Helical computed tomography (CT) scanning of the abdomen and pelvis can be used when a routine workup [emedicine.medscape.com]

• Multiple Ulcerations

  The combination effect of both S typhi and T. trichiura led to multiple ulcerations and severe bleeding which caused hypovolemic shock. [dx.doi.org]

• Ischemic Changes

  No ischemic change was observed in any patients in group Ia and in two patients in group Ib. Ischemic changes were observed in six group Ib patients and both group II patients. [ncbi.nlm.nih.gov]

(initial hemoglobin level, need for packed red blood cells), and treatment efficiency (necessary reoperation). [ncbi.nlm.nih.gov]

We conclude that in patients with active gastrointestinal bleeding, colonoscopy in combination with scintigraphy detect at a higher rate the cause and the site of bleeding and possibly improve the prognosis. [ncbi.nlm.nih.gov]

We performed such a study to evaluate the clinical presentation, outcome, and mortality as well as clinical variables associated with poor prognosis. Methods. [tandfonline.com]

Tindall, Shauna Sherker, Julie Rae, John Wiggers 19 March 2019 View Current Issue Cochrane's plans to update its COI policy: truth and fiction David Tovey, Fergus Macbeth, Angela Webster, Ruth Foxlee 30 November 2018 Implementing systematic reviews of prognosis [cochranelibrary.com]

Our study was not aimed at identifying the risk factors for poor outcome and has insufficient power to show significant predictive parameters for the overall prognosis of these patients. [journals.lww.com]

Surgery is the definitive treatment--it confirms the etiology and rules out the presence of malignancy. [ncbi.nlm.nih.gov]

Etiology and Work-Up Assessment of the etiology of hematochezia begins with ruling out an upper GI source of the bleed; 10% to 15% of patients presenting with hematochezia without hematemesis are ultimately diagnosed with an upper GI etiology. 4,5 BUN-to-Cr [mdedge.com]

Lewis: Center for Clinical Epidemiology and Biostatistics, Blockley Hall, 9th Floor, 423 Guardian Drive, Philadelphia, PA 19104-6021. Dr. [dx.doi.org]

Lower GI bleeding: epidemiology and diagnosis. Gastroenterol Clin North Am. 2005;34:643-64. Lanas A, Garcia-Rodriguez LA, Polo-Tomas M, Ponce M, Alonso-Abreu I, Perez-Aisa MA, et al. [ijmedicine.com]

What is the pathophysiology of ischemic colitis? Lower gastrointestinal (GI) bleeding refers to bleeding that occurs from a source in the colon, rectum, or anus. [accessmedicine.mhmedical.com]

Sleisenger and Fordtran’s gastrointestinal and liver disease: pathophysiology, diagnosis, management, 7th ed. Philadelphia; Saunders 2002 C. Ell, M. D., Ph. D. [dx.doi.org]

Etiology and pathophysiology Acute upper GI bleeding may originate in the esophagus, stomach, and duodenum. [wjgnet.com]

《World journal of gastrointestinal pathophysiology》 5 (4): 467–78. doi:10.4291/wjgp.v5.i4.467. PMID 25400991. ↑ 가 나 다 라 마 바 Westhoff, John (March 2004). “Gastrointestinal Bleeding: An Evidence-Based ED Approach To Risk Stratification”. [ko.wikipedia.org]

It also appears that therapeutic colonoscopy can arrest or prevent bleeding in certain high-risk patients, offering the opportunity to change the natural history of the bleed. [ncbi.nlm.nih.gov]

WHA70.12: Cancer prevention and control in the context of an integrated approach Global action plan for the prevention and control of NCDs 2013-2020 WHO and IARC collaborate with other UN organizations within the UN Interagency Task Force on the Prevention [who.int]