Questions and Answers
What is considered significant lower gastrointestinal bleeding in terms of fecal blood loss?
What percentage of lower gastrointestinal bleeds typically resolve spontaneously?
Which age-related trend is observed regarding lower gastrointestinal bleeding incidence?
What percentage of lower GI bleeds originate from the small intestine?
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What type of bleeding can hematochezia indicate when associated with hemodynamic instability?
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Which of the following is NOT a recognized category for classifying lower GI bleeding?
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In which population should brisk UGIB be particularly considered when observing hematochezia?
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What may an elevated blood urea nitrogen to creatinine ratio indicate in the context of bleeding?
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Which of the following conditions may lead to lower gastrointestinal bleeding?
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The occurrence of lower GI bleeding in the context of diverticular disease is classified under which etiology?
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What symptom is typically associated with diverticular bleeding?
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Which condition is NOT typically associated with the presence of pain during lower gastrointestinal bleeding?
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Which type of stool characteristics suggest bleeding from a source proximal to the ligament of Treitz?
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Which of the following is considered the gold standard for evaluating lower GI bleeding?
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In which scenario would a fecal sample likely contain blood with mucus?
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Which finding suggests a colonic source of bleeding during a clinical examination?
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What is the minimum bleeding rate that CT angiography can detect for conditions like angiodysplasia?
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Which of the following is a sign characteristic of inflammatory bowel disease?
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Which condition typically presents with blood alone in the stool?
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What should be prioritized during the evaluation of a patient presenting with lower GI bleeding?
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Study Notes
Lower Gastrointestinal Bleeding (LGIB) Overview
- Defined as bleeding occurring below the ligament of Treitz.
- Normal fecal blood loss is approximately 1.2 ml/day; significant if exceeding 10 ml/day.
- Hematochezia may present as bright red blood or old clots; melena indicates slow bleeding from a proximal source.
Incidence of LGIB
- Accounts for 22-30% of gastrointestinal bleeding.
- Lower GI bleeding is one-third as common as upper gastrointestinal hemorrhage.
- Approximately 80-85% of cases originate distal to the ileocecal valve; only 0.7-9% arise from the small intestine.
- 80% of lower GI bleeds resolve spontaneously, with a recurrence rate of 25%.
- Incidence markedly increases with age.
Classification of LGIB
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By Etiology:
- Congenital: Polyps, Meckel’s diverticulum, hereditary hemorrhagic telangiectasia.
- Inflammatory: Ulcerative colitis, infectious colitis, amoebic dysentery, Crohn’s disease.
- Neoplastic: Adenomas, carcinomas, polyps.
- Vascular: Angiodysplasia, ischemic colitis, vasculitis, hemangiomas.
- Clotting Disorders: Hemophilia, leukemia, warfarin therapy, disseminated intravascular coagulation (DIC).
- Miscellaneous: Hemorrhoids, anal fissures, rectal injury.
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By Pain Experience:
- With Pain: Anorectal conditions such as fissures, fistulas, perianal hematomas, abscesses.
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Without Pain:
- Blood Alone: Polyps, villous adenomas, diverticular disease.
- Blood After Defecation: Hemorrhoids.
- Blood with Mucus: Ulcerative colitis, intussusception, ischemic colitis.
- Blood Streaked on Stool: Rectal carcinoma.
Clinical Presentation
- Painless large-volume bleeding suggests diverticular bleeding.
- Bloody diarrhea with abdominal cramps signifies inflammatory bowel disease, infectious colitis, or ischemic colitis.
- Brown stools mixed or streaked with blood indicates a source in the rectosigmoid or anus.
- Large volumes of bright red blood indicate a colonic source; maroon stools suggest lesions in the right colon or small intestine.
- Black stools (melena) predict a source proximal to the ligament of Treitz.
Diagnostic Tools
- Comprehensive history and clinical examination, specifically inspecting the perianal area if hemorrhoids are suspected.
- Colonoscopy: Gold standard for diagnosis.
- CT Angiography: Detects bleeding rates of 0.5 ml/min, useful for angiodysplasia and tumors.
- Radionuclear Scanning: Identifies bleeding as low as 0.1 ml/min.
Patient Management
- Patients stratified as stable or unstable, with unstable defined as a shock index >1.
- Management involves detailed history taking, examination, and appropriate diagnostic testing to determine underlying causes.
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Description
This quiz provides a thorough overview of Lower Gastrointestinal Bleeding (LGIB), including its definition, incidence, and classification by etiology. Understand the common causes and statistical data associated with LGIB to better grasp its significance in gastrointestinal health.
