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A lower gastrointestinal bleed is defined as bleeding originating distal to the ileocecal valve, which includes the colon, rectum, and anus. [2] LGIB was previously defined as any bleed that occurs distal to the ligament of Treitz, which included the aforementioned parts of the intestine and also included the last 1/4 of the duodenum and the entire area of the jejunum and ileum. [1]
Bleeding ulcers may be treated by endoscopy, with open surgery typically only used in cases in which it is not successful. [2] Peptic ulcers are present in around 4% of the population. [1] New ulcers were found in around 87.4 million people worldwide during 2015. [5] About 10% of people develop a peptic ulcer at some point in their life. [9]
Patients may have unstable vital signs if they have been having rectal bleeding, have developed stercoral colitis, and/or have had a perforation of the ulcer. These vital sign changes may be an acute fever, elevated heart rate, and/or decreased blood pressure. Laboratory evaluation may not be as specific in pointing to a diagnosis.
Classically, there is a solitary ulcer. But only 20% of patients have a single ulcer whereas in other cases there may be multiple lesions. [6] The size of the ulcers is usually 0.5–4 cm. [5] The lesion is most often located on the anterior (front) or lateral (side) rectal wall, centered on a rectal fold, [1] usually 10 cm from the anal verge. [8]
Despite treatment, re-bleeding occurs in about 7–16% of those with upper GI bleeding. [3] In those with esophageal varices, bleeding occurs in about 5–15% a year and if they have bled once, there is a higher risk of further bleeding within six weeks. [13] Testing and treating H. pylori if found can prevent re-bleeding in those with peptic ...
Upper gastrointestinal bleeding can be caused by peptic ulcers, gastric erosions, esophageal varices, and rarer causes such as gastric cancer. The initial assessment includes measurement of the blood pressure and heart rate , as well as blood tests to determine the hemoglobin .
Solitary rectal ulcer syndrome (SRUS) is a rare benign disease characterized by symptoms, clinical findings, and histological abnormalities. [9] Only 40% of patients have ulcers; 20% of patients have a single ulcer, and the remaining lesions range in size and form from broad-based polypoid to hyperemic mucosa. [10]
Endoscopy image of a duodenal ulcer in the posterior part of the duodenal bulb without stigmata of recent hemorrhage. This would be a Forrest III lesion. Acute hemorrhage. Forrest I a (Spurting hemorrhage) Forrest I b (Oozing hemorrhage) Signs of recent hemorrhage. Forrest II a (Non bleeding Visible vessel) Forrest II b (Adherent clot)