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Dr. Andrew Rynne
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Article Home Adult and Senior Health Lower gastro intestinal bleeding (LGIB)

Lower gastro intestinal bleeding (LGIB)

Lower gastrointestinal bleeding accounts for 20- 30% of gastrointestinal hemorrhage. Although lower gastrointestinal bleeding is less common than upper gastrointestinal bleeding. The bleeding ranging from trivial hematochezia to massive hemorrhage with shock.


LGIB is common is the elderly than in younger people because diverticulosis and malingant of colon are more common in these groups.

Causes of LGIB

  • Colitis- Ischemic colitis, ulcerative colitis, radiation induced colitis
  • Infection colitis with E- coli, shigella, C. difficle, Campylobacter jejuni
  • Non infectious colitis (idiopathic) Like Crohns or ulcerative colitis
  • Anorectal disease- hemorrhoids, fissures and fistulas
  • Diverticular disease- diverticulosis, diverticulitis
  • HIV related opportunistic infection- CMV colitis, Kaposi sarcoma and lymphoma
  • Drug induced bleeding- Aspirin and anticoagulants
  • Vascular- Angiodyplasia, polyarteritis nodosa, Wegener’s granulomatosis, and aortocolonic fistulas
  • General causes: Salicylates, alchohol, liver failure, renal failure, Ingestion of steroids and NSAID's.
  • Small intestinal causes: Intussusceptions and Meckel’s diverticulum
  • Neoplasm- Colon cancer, postpolypectomty bleeding 

Signs and symptoms

  • Rectal bleeding
  • Blood in the stools
  • Blood on the toilet paper
  • Pallor
  • Shortness of breathe
  • Weakness 

Tests and diagnosis

  • Complete blood count
  • Serum electrolytes
  • Renal function test (blood urea and serum creatinine)
  • Coagulation profile (Prothrombin time and INR)
  • Colonoscopy
  • Radionuclide Imaging
  • Angiography
  • Upper GI endoscopy and enteroscopy 


Medication: Posterior pituitary hormones – Vasopressin and Terlipressin

Modern endoscopic techniques such as injection sclerotherapy, thermo coagulation and laser coagulation seem to be effective in achieving hemostasis and avoiding precarious surgery.

Indications for surgery 

  • Persistent hemodynamic instability with active bleeding
  • Persistent, recurrent bleeding
  • Transfusion of more than 4 units packed red blood cells