1. LOWER GI BLEEDS Jeeves

2. Definition  The loss of blood from the GI tract distal to the ligament of Trietz.  This is the anatomical marker for the junction between the duodenum and the jejunum.

3. Causes Causes of lower GI haemorrhage in adults Percentage of pts Diverticular disease -Diverticulosis/diverticulitis of small intestine -Diverticulosis/diverticulitis of colon 60% IBD -Crohn's disease of small bowel, colon, or both -Ulcerative colitis -Noninfectious gastroenteritis and colitis 13% Benign anorectal diseases -Hemorrhoids -Anal fissures -Anal fistulas 11% Neoplasia -Malignant neoplasia of small intestine -Malignant neoplasia of colon, rectum, and anus 9% Coagulopathy4% Arteriovenous malformations (AVM)3% TOTAL100% Meckel diverticulum, intussusception, polyposis syndromes, and IBD are the common causes of GI bleeding in children and adolescents

4. Signs and Symptoms  Maroon/red stained stools (hematochezia) or bright red blood from the rectum.  Malaena may also occur but it points more towards upper GI bleeds.  Hypotension; tachycardia  Pallour, weakness, fainting and other signs of anaemia (if chronic)  Perform History and ask about IBD, weight loss, FHx of Ca, stomach pain, bleeding disorders, last period.