LGI Bleed

Question 1

What are lower GI bleeds characterised by?

Answer 1

Bleeding distal to ligament of Treitz

Question 2

Is faecal blood loss normal?

Answer 2

• ONLY AT 1.2 mL per day
• Significant if greater than 10 ml per day

Question 3

What do LGI bleeds typically present with?

Answer 3

• Melaena - Passage of black, tarry stools.
• Haematochezia - Passage of fresh blood per anus, usually in or with stools

Question 4

What are the 3 categories of LGI bleeds?

Answer 4

MASSIVE
MODERATE
OCCULT

Question 5

How are occult bleeds identified?

Answer 5

• Routine chemical testing of stool with or without systemic evidence of chronic blood loss
• 10 ml of blood loss per day - necessary for stool to be occult blood positive

Question 6

What are the current screening and confirmatory tests for bowel cancer in the UK?

Answer 6

• FIT tests
• Colonoscopy
• CT Colonography

Question 7

What are 3 ways LGI bleeds can be classified?

Answer 7

• Presence or absence of pain
• Site of bleeding
• Aetiology

Question 8

Name some aetiologies of LGI bleeding in the small intestine.

Answer 8

• Crohn’s disease
• Inflammatory diarrhoea (e.g. shigella)
• Angiodysplasia

Question 9

Name some aetiologies of LGI bleeding in the colon and rectum.

Answer 9

SAME AS SMALL INTESTINE
Also:
- Diverticular disease
- Ulcerative colitis
- Proctitis
- Colon cancer
- Colonic polyps

Question 10

Name some aetiologies of LGI bleeding in the anus.

Answer 10

Haemorrhoids
Anal fissure
Rectal cancer
Trauma

Question 11

What are the favored investigations for LGI bleeding?

Answer 11

• COLONOSCOPY
• ANGIOGRAPHY
• May also do blood tests and stool examinations