Lower gastrointestinal bleeding

Rationale

Lower gastrointestinal bleeding is defined as blood originating distal to the ligament of Treitz. It can present as frank bleeding (hematochezia) or as occult blood loss. Although commonly seen in benign conditions, it may be the first presentation of malignancy.

Causal Conditions

(list not exhaustive)

1. Colorectal cancer or polyps
2. Diverticulosis
3. Angiodysplasia
4. Anorectal disease
5. Enterocolitis
6. Brisk bleeding from the upper gastrointestinal tract
7. Rectal trauma

Key Objectives

Particular attention should be given to the hemodynamic status of the patient and the need for immediate specialized care. The candidate should also identify patients at high risk of colorectal cancer for screening colonoscopy.

Enabling Objectives

Given a patient with lower gastrointestinal tract bleeding, the candidate will

1. list and interpret critical clinical findings, including
   1. assess through history and physical examination, including a rectal examination as part of the initial assessment;
   2. assess the hemodynamic status;
2. list and interpret critical clinical investigations, including
   1. perform colonoscopy as appropriate;
   2. select additional investigations as appropriate;
3. construct an effective initial management plan, including
   1. identify patients in need of immediate resuscitation and referral for specialized care.