Blood in stool but no hemorrhoids

Lower gastrointestinal bleeding, commonly abbreviated LGIB, is any form of gastrointestinal bleeding in the lower gastrointestinal tract. LGIB is a common reason for seeking medical attention at a hospital’s emergency department. A lower gastrointestinal bleed is defined as bleeding originating distal to the ileocecal valve which includes the colon, rectum, and anus. Black tarry appearing stools medically referred to as melena usually indicates blood that has been in the GI tract for at least 8 hours. 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.

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Diagnostic evaluation must be performed after patients have been adequately resuscitated. If an upper GI source is suspected, an upper endoscopy should be performed first. Evaluate for abdominal tenderness, masses, and enlargement of the liver and spleen. Additional key elements include a careful and thorough inspection of the anus, palpation for rectal masses, characterization of the stool color, and a stool guaiac card test to evaluate for the presence of blood. Among the blood tests that should be performed are a complete blood count, prothrombin time, partial thromboplastin time, electrolytes, and typing and cross-matching for transfusion of blood products. Anoscopy is useful only for diagnosing bleeding sources from the anorectal junction and anal canal, including internal hemorrhoids and anal fissures.

It is superior to flexible sigmoidoscopy for detecting hemorrhoids in an outpatient setting and can be performed quickly in the office or at the bedside as an adjunct to flexible sigmoidoscopy and colonoscopy. Flexible sigmoidoscopy uses a 65-cm long sigmoidoscope that visualizes the left colon. It can be performed without sedation and only minimal preparation with enemas. Colonoscopy is the test of choice in the majority of patients with acute Lower GI bleeding as it can be both diagnostic and therapeutic. Basic algorithm for the management of lower GI bleed. In most cases requiring emergency hospital admission, the bleeding will resolve spontaneously.

Predicting which patients will suffer adverse outcomes, complications or severe bleeding can be difficult. 24 hours as risk factors for worse outcome. Surgical intervention is warranted in cases of LGIB that persist despite attempts to stop the bleeding with endoscopic or interventional radiology interventions. An uncommon cause of lower gastrointestinal bleeding: a case report”. The American College of Gastroenterology Bleeding Registry: preliminary findings”. Early predictors of severity in acute lower intestinal tract bleeding”. Urgent colonoscopy for evaluation and management of acute lower gastrointestinal hemorrhage: a randomized controlled trial”.

Early predictors of severe lower gastrointestinal bleeding and adverse outcomes: a prospective study”. Validation of a clinical prediction rule for severe acute lower intestinal bleeding”. Outcome predictors in acute surgical admissions for lower gastrointestinal bleeding”. Lower gastrointestinal bleeding, commonly abbreviated LGIB, is any form of gastrointestinal bleeding in the lower gastrointestinal tract. LGIB is a common reason for seeking medical attention at a hospital’s emergency department. A lower gastrointestinal bleed is defined as bleeding originating distal to the ileocecal valve which includes the colon, rectum, and anus. Black tarry appearing stools medically referred to as melena usually indicates blood that has been in the GI tract for at least 8 hours. 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.

Diagnostic evaluation must be performed after patients have been adequately resuscitated. If an upper GI source is suspected, an upper endoscopy should be performed first. Evaluate for abdominal tenderness, masses, and enlargement of the liver and spleen. Additional key elements include a careful and thorough inspection of the anus, palpation for rectal masses, characterization of the stool color, and a stool guaiac card test to evaluate for the presence of blood. Among the blood tests that should be performed are a complete blood count, prothrombin time, partial thromboplastin time, electrolytes, and typing and cross-matching for transfusion of blood products. Anoscopy is useful only for diagnosing bleeding sources from the anorectal junction and anal canal, including internal hemorrhoids and anal fissures. It is superior to flexible sigmoidoscopy for detecting hemorrhoids in an outpatient setting and can be performed quickly in the office or at the bedside as an adjunct to flexible sigmoidoscopy and colonoscopy. Flexible sigmoidoscopy uses a 65-cm long sigmoidoscope that visualizes the left colon.

It can be performed without sedation and only minimal preparation with enemas. Colonoscopy is the test of choice in the majority of patients with acute Lower GI bleeding as it can be both diagnostic and therapeutic. Basic algorithm for the management of lower GI bleed. In most cases requiring emergency hospital admission, the bleeding will resolve spontaneously. Predicting which patients will suffer adverse outcomes, complications or severe bleeding can be difficult. 24 hours as risk factors for worse outcome.

Surgical intervention is warranted in cases of LGIB that persist despite attempts to stop the bleeding with endoscopic or interventional radiology interventions. An uncommon cause of lower gastrointestinal bleeding: a case report”. The American College of Gastroenterology Bleeding Registry: preliminary findings”. Early predictors of severity in acute lower intestinal tract bleeding”. Urgent colonoscopy for evaluation and management of acute lower gastrointestinal hemorrhage: a randomized controlled trial”. Early predictors of severe lower gastrointestinal bleeding and adverse outcomes: a prospective study”. Validation of a clinical prediction rule for severe acute lower intestinal bleeding”.

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