Lower GIT Bleeding

Presented by

Students no (31-50)

Round 1

Definition

bull Lower gastrointestinal bleeding (LGIB) is defined as that occurring distal to the ligament of Treitz (ie from the jejunum ileum colon rectum or anus) and presenting as either haematochezia (bright red bloodclots) or melaena

Epidemiology

bull The incidence of LGIB is only one-fifth that of the upper gastrointestinal tract and is estimated to be ~24 per 100 000 adults per year

bull Male and older patients tend to suffer from more severe LGIB

Risk factors

bull medications (eg NSAID warfarin)

bull recent colonoscopy with polypectomy(postpolypectomy bleeding)

bull prior abdominalpelvic radiation (radiation proctitiscolitis)

bull prior operation

bull history of alcoholism or chronic liver disease

bull history of abdominal aortic anuerysm with or without surgical repair (aortoenteric fistula)

Causes

bull Diverticular diseasebull enterocolitis

ndash infectivendash Crohnrsquos diseasendash Ulcerative colitis ndash Ischemic colitis

bull vascular malformationndash vascular ectasiandash Angiodysplasiandash arteriovenous malformation (AVM)

bull polypbull tumourbull Vasculitidesbull Portal hypertensive enteropathy or colopathybull Meckel diverticulumbull ulcerbull Aorto-enteric fistula bull Anal fissure bull Haemorrhoidsbull Perianal fistula

Aetiology

bull Although LGIB can occur at any age specific disease processes are distinctive for different age groups and familiarity with this can help tailor the diagnostic workup

-adolescents and young adults inflammatory bowel diseases polyps Meckelrsquos diverticulum

-up to 60 years diverticula inflammatory bowel diseases malignancy

-older than 60 years arteriovenousmalformations diverticula malignancy

Clinical presentation

bull Acute bleeding is defined as bleeding of lt3 days duration resulting in instability of vital signs anaemia andor the need for blood transfusion

bull Chronic bleeding is defined as slow blood loss over a period of several days or longer presenting with symptoms of occult faecal blood intermittent melaena or scant hematochezia

bull LGIB usually is chronic and the bleeding ceases spontaneously (80)

Diverticular disease

bull Out-pouchings of bowel result in blind-ended diverticulae in communication with the lumen of the bowel

bull They most commonly occur within the sigmoid colon although they may be present throughout the bowel

Clinical presentation

bull The vast majority of people with diverticulosisare asymptomatic

bull Patients complain of intermittent left sided abdominal pain and frequent constipation Symptomatic presenting features of diverticular disease (ie presentation of complicated diverticulosis) includes

-diverticulitis

-GIT hemorrhage

Crohnrsquos disease

bull idiopathic inflammatory bowel disease characterised by widespread GIT involvement typically with skip lesions thereby its synonym regional enteritis and frequently systemic involvement

Clinical presentation

bull Clinical presentation is typically with chronic diarrhoea and recurrent abdominal pain

bull Alternatively patients may present with one of the many complications or extraintestinalmanifestations

-skin hellip

-joints hellip

-eyes hellip

-liver and biliary system hellip

Ulcerative colitis

bull inflammatory bowel disease which predominantly affects the colon but also has extraintestinal manifestations

bull Clinically patients have chronic diarrhoea(sometimes bloody) associated with tenesmus pain and fever

Ischaemic colitis

bull inflammation of the colon secondary to vascular insufficiency and ischaemia

bull It sometimes considered under the same spectrum of intestinal ischeamia

bull The severity and consequences of the disease are highly variable

Clinical presentation

bull Presenting symptoms include abdominal pain and bloody

bull Tenderness may be present particularly of the left side of the abdomen

bull In severe cases where necrosis and perforation have occurred the signs and symptoms are those of peritonitis

Vasculitis

bull generalised inflammation of vessels Vasculidities carry a broad range of clinical presentations and as a whole can involve almost any organ system

Pathology

bull Some vasculitides are due to direct vessel injury from an infectious agent However a large proportion show evidence of immune complex related vessel wall injury

Classification

-Takayasu arteritis

-Wegener granulomatosis

-Henoch-Schoumlnlein purpura

-Churg-Strauss syndrome

Primary vasculitides -infection related

vasculitis

- SLE rheumatoid arthritis

-malignancy related vasculitis

Secondary vasculitides

Definition

bull Lower gastrointestinal bleeding (LGIB) is defined as that occurring distal to the ligament of Treitz (ie from the jejunum ileum colon rectum or anus) and presenting as either haematochezia (bright red bloodclots) or melaena

Epidemiology

bull The incidence of LGIB is only one-fifth that of the upper gastrointestinal tract and is estimated to be ~24 per 100 000 adults per year

bull Male and older patients tend to suffer from more severe LGIB

Risk factors

bull medications (eg NSAID warfarin)

bull recent colonoscopy with polypectomy(postpolypectomy bleeding)

bull prior abdominalpelvic radiation (radiation proctitiscolitis)

bull prior operation

bull history of alcoholism or chronic liver disease

bull history of abdominal aortic anuerysm with or without surgical repair (aortoenteric fistula)

Causes

bull Diverticular diseasebull enterocolitis

ndash infectivendash Crohnrsquos diseasendash Ulcerative colitis ndash Ischemic colitis

bull vascular malformationndash vascular ectasiandash Angiodysplasiandash arteriovenous malformation (AVM)

bull polypbull tumourbull Vasculitidesbull Portal hypertensive enteropathy or colopathybull Meckel diverticulumbull ulcerbull Aorto-enteric fistula bull Anal fissure bull Haemorrhoidsbull Perianal fistula

Aetiology

bull Although LGIB can occur at any age specific disease processes are distinctive for different age groups and familiarity with this can help tailor the diagnostic workup

-adolescents and young adults inflammatory bowel diseases polyps Meckelrsquos diverticulum

-up to 60 years diverticula inflammatory bowel diseases malignancy

-older than 60 years arteriovenousmalformations diverticula malignancy

Clinical presentation

bull Acute bleeding is defined as bleeding of lt3 days duration resulting in instability of vital signs anaemia andor the need for blood transfusion

bull Chronic bleeding is defined as slow blood loss over a period of several days or longer presenting with symptoms of occult faecal blood intermittent melaena or scant hematochezia

bull LGIB usually is chronic and the bleeding ceases spontaneously (80)

Diverticular disease

bull Out-pouchings of bowel result in blind-ended diverticulae in communication with the lumen of the bowel

bull They most commonly occur within the sigmoid colon although they may be present throughout the bowel

Clinical presentation

bull The vast majority of people with diverticulosisare asymptomatic

bull Patients complain of intermittent left sided abdominal pain and frequent constipation Symptomatic presenting features of diverticular disease (ie presentation of complicated diverticulosis) includes

-diverticulitis

-GIT hemorrhage

Crohnrsquos disease

bull idiopathic inflammatory bowel disease characterised by widespread GIT involvement typically with skip lesions thereby its synonym regional enteritis and frequently systemic involvement

Clinical presentation

bull Clinical presentation is typically with chronic diarrhoea and recurrent abdominal pain

bull Alternatively patients may present with one of the many complications or extraintestinalmanifestations

-skin hellip

-joints hellip

-eyes hellip

-liver and biliary system hellip

Ulcerative colitis

bull inflammatory bowel disease which predominantly affects the colon but also has extraintestinal manifestations

bull Clinically patients have chronic diarrhoea(sometimes bloody) associated with tenesmus pain and fever

Ischaemic colitis

bull inflammation of the colon secondary to vascular insufficiency and ischaemia

bull It sometimes considered under the same spectrum of intestinal ischeamia

bull The severity and consequences of the disease are highly variable

Clinical presentation

bull Presenting symptoms include abdominal pain and bloody

bull Tenderness may be present particularly of the left side of the abdomen

bull In severe cases where necrosis and perforation have occurred the signs and symptoms are those of peritonitis

Vasculitis

bull generalised inflammation of vessels Vasculidities carry a broad range of clinical presentations and as a whole can involve almost any organ system

Pathology

bull Some vasculitides are due to direct vessel injury from an infectious agent However a large proportion show evidence of immune complex related vessel wall injury

Classification

-Takayasu arteritis

-Wegener granulomatosis

-Henoch-Schoumlnlein purpura

-Churg-Strauss syndrome

Primary vasculitides -infection related

vasculitis

- SLE rheumatoid arthritis

-malignancy related vasculitis

Secondary vasculitides

Epidemiology

bull The incidence of LGIB is only one-fifth that of the upper gastrointestinal tract and is estimated to be ~24 per 100 000 adults per year

bull Male and older patients tend to suffer from more severe LGIB

Risk factors

bull medications (eg NSAID warfarin)

bull recent colonoscopy with polypectomy(postpolypectomy bleeding)

bull prior abdominalpelvic radiation (radiation proctitiscolitis)

bull prior operation

bull history of alcoholism or chronic liver disease

bull history of abdominal aortic anuerysm with or without surgical repair (aortoenteric fistula)

Causes

bull Diverticular diseasebull enterocolitis

ndash infectivendash Crohnrsquos diseasendash Ulcerative colitis ndash Ischemic colitis

bull vascular malformationndash vascular ectasiandash Angiodysplasiandash arteriovenous malformation (AVM)

bull polypbull tumourbull Vasculitidesbull Portal hypertensive enteropathy or colopathybull Meckel diverticulumbull ulcerbull Aorto-enteric fistula bull Anal fissure bull Haemorrhoidsbull Perianal fistula

Aetiology

bull Although LGIB can occur at any age specific disease processes are distinctive for different age groups and familiarity with this can help tailor the diagnostic workup

-adolescents and young adults inflammatory bowel diseases polyps Meckelrsquos diverticulum

-up to 60 years diverticula inflammatory bowel diseases malignancy

-older than 60 years arteriovenousmalformations diverticula malignancy

Clinical presentation

bull Acute bleeding is defined as bleeding of lt3 days duration resulting in instability of vital signs anaemia andor the need for blood transfusion

bull Chronic bleeding is defined as slow blood loss over a period of several days or longer presenting with symptoms of occult faecal blood intermittent melaena or scant hematochezia

bull LGIB usually is chronic and the bleeding ceases spontaneously (80)

Diverticular disease

bull Out-pouchings of bowel result in blind-ended diverticulae in communication with the lumen of the bowel

bull They most commonly occur within the sigmoid colon although they may be present throughout the bowel

Clinical presentation

bull The vast majority of people with diverticulosisare asymptomatic

bull Patients complain of intermittent left sided abdominal pain and frequent constipation Symptomatic presenting features of diverticular disease (ie presentation of complicated diverticulosis) includes

-diverticulitis

-GIT hemorrhage

Crohnrsquos disease

bull idiopathic inflammatory bowel disease characterised by widespread GIT involvement typically with skip lesions thereby its synonym regional enteritis and frequently systemic involvement

Clinical presentation

bull Clinical presentation is typically with chronic diarrhoea and recurrent abdominal pain

bull Alternatively patients may present with one of the many complications or extraintestinalmanifestations

-skin hellip

-joints hellip

-eyes hellip

-liver and biliary system hellip

Ulcerative colitis

bull inflammatory bowel disease which predominantly affects the colon but also has extraintestinal manifestations

bull Clinically patients have chronic diarrhoea(sometimes bloody) associated with tenesmus pain and fever

Ischaemic colitis

bull inflammation of the colon secondary to vascular insufficiency and ischaemia

bull It sometimes considered under the same spectrum of intestinal ischeamia

bull The severity and consequences of the disease are highly variable

Clinical presentation

bull Presenting symptoms include abdominal pain and bloody

bull Tenderness may be present particularly of the left side of the abdomen

bull In severe cases where necrosis and perforation have occurred the signs and symptoms are those of peritonitis

Vasculitis

bull generalised inflammation of vessels Vasculidities carry a broad range of clinical presentations and as a whole can involve almost any organ system

Pathology

bull Some vasculitides are due to direct vessel injury from an infectious agent However a large proportion show evidence of immune complex related vessel wall injury

Classification

-Takayasu arteritis

-Wegener granulomatosis

-Henoch-Schoumlnlein purpura

-Churg-Strauss syndrome

Primary vasculitides -infection related

vasculitis

- SLE rheumatoid arthritis

-malignancy related vasculitis

Secondary vasculitides

Risk factors

bull medications (eg NSAID warfarin)

bull recent colonoscopy with polypectomy(postpolypectomy bleeding)

bull prior abdominalpelvic radiation (radiation proctitiscolitis)

bull prior operation

bull history of alcoholism or chronic liver disease

bull history of abdominal aortic anuerysm with or without surgical repair (aortoenteric fistula)

Causes

bull Diverticular diseasebull enterocolitis

ndash infectivendash Crohnrsquos diseasendash Ulcerative colitis ndash Ischemic colitis

bull vascular malformationndash vascular ectasiandash Angiodysplasiandash arteriovenous malformation (AVM)

bull polypbull tumourbull Vasculitidesbull Portal hypertensive enteropathy or colopathybull Meckel diverticulumbull ulcerbull Aorto-enteric fistula bull Anal fissure bull Haemorrhoidsbull Perianal fistula

Aetiology

bull Although LGIB can occur at any age specific disease processes are distinctive for different age groups and familiarity with this can help tailor the diagnostic workup

-adolescents and young adults inflammatory bowel diseases polyps Meckelrsquos diverticulum

-up to 60 years diverticula inflammatory bowel diseases malignancy

-older than 60 years arteriovenousmalformations diverticula malignancy

Clinical presentation

bull Acute bleeding is defined as bleeding of lt3 days duration resulting in instability of vital signs anaemia andor the need for blood transfusion

bull Chronic bleeding is defined as slow blood loss over a period of several days or longer presenting with symptoms of occult faecal blood intermittent melaena or scant hematochezia

bull LGIB usually is chronic and the bleeding ceases spontaneously (80)

Diverticular disease

bull Out-pouchings of bowel result in blind-ended diverticulae in communication with the lumen of the bowel

bull They most commonly occur within the sigmoid colon although they may be present throughout the bowel

Clinical presentation

bull The vast majority of people with diverticulosisare asymptomatic

bull Patients complain of intermittent left sided abdominal pain and frequent constipation Symptomatic presenting features of diverticular disease (ie presentation of complicated diverticulosis) includes

-diverticulitis

-GIT hemorrhage

Crohnrsquos disease

bull idiopathic inflammatory bowel disease characterised by widespread GIT involvement typically with skip lesions thereby its synonym regional enteritis and frequently systemic involvement

Clinical presentation

bull Clinical presentation is typically with chronic diarrhoea and recurrent abdominal pain

bull Alternatively patients may present with one of the many complications or extraintestinalmanifestations

-skin hellip

-joints hellip

-eyes hellip

-liver and biliary system hellip

Ulcerative colitis

bull inflammatory bowel disease which predominantly affects the colon but also has extraintestinal manifestations

bull Clinically patients have chronic diarrhoea(sometimes bloody) associated with tenesmus pain and fever

Ischaemic colitis

bull inflammation of the colon secondary to vascular insufficiency and ischaemia

bull It sometimes considered under the same spectrum of intestinal ischeamia

bull The severity and consequences of the disease are highly variable

Clinical presentation

bull Presenting symptoms include abdominal pain and bloody

bull Tenderness may be present particularly of the left side of the abdomen

bull In severe cases where necrosis and perforation have occurred the signs and symptoms are those of peritonitis

Vasculitis

bull generalised inflammation of vessels Vasculidities carry a broad range of clinical presentations and as a whole can involve almost any organ system

Pathology

bull Some vasculitides are due to direct vessel injury from an infectious agent However a large proportion show evidence of immune complex related vessel wall injury

Classification

-Takayasu arteritis

-Wegener granulomatosis

-Henoch-Schoumlnlein purpura

-Churg-Strauss syndrome

Primary vasculitides -infection related

vasculitis

- SLE rheumatoid arthritis

-malignancy related vasculitis

Secondary vasculitides

Causes

bull Diverticular diseasebull enterocolitis

ndash infectivendash Crohnrsquos diseasendash Ulcerative colitis ndash Ischemic colitis

bull vascular malformationndash vascular ectasiandash Angiodysplasiandash arteriovenous malformation (AVM)

bull polypbull tumourbull Vasculitidesbull Portal hypertensive enteropathy or colopathybull Meckel diverticulumbull ulcerbull Aorto-enteric fistula bull Anal fissure bull Haemorrhoidsbull Perianal fistula

Aetiology

bull Although LGIB can occur at any age specific disease processes are distinctive for different age groups and familiarity with this can help tailor the diagnostic workup

-adolescents and young adults inflammatory bowel diseases polyps Meckelrsquos diverticulum

-up to 60 years diverticula inflammatory bowel diseases malignancy

-older than 60 years arteriovenousmalformations diverticula malignancy

Clinical presentation

bull Acute bleeding is defined as bleeding of lt3 days duration resulting in instability of vital signs anaemia andor the need for blood transfusion

bull Chronic bleeding is defined as slow blood loss over a period of several days or longer presenting with symptoms of occult faecal blood intermittent melaena or scant hematochezia

bull LGIB usually is chronic and the bleeding ceases spontaneously (80)

Diverticular disease

bull Out-pouchings of bowel result in blind-ended diverticulae in communication with the lumen of the bowel

bull They most commonly occur within the sigmoid colon although they may be present throughout the bowel

Clinical presentation

bull The vast majority of people with diverticulosisare asymptomatic

bull Patients complain of intermittent left sided abdominal pain and frequent constipation Symptomatic presenting features of diverticular disease (ie presentation of complicated diverticulosis) includes

-diverticulitis

-GIT hemorrhage

Crohnrsquos disease

bull idiopathic inflammatory bowel disease characterised by widespread GIT involvement typically with skip lesions thereby its synonym regional enteritis and frequently systemic involvement

Clinical presentation

bull Clinical presentation is typically with chronic diarrhoea and recurrent abdominal pain

bull Alternatively patients may present with one of the many complications or extraintestinalmanifestations

-skin hellip

-joints hellip

-eyes hellip

-liver and biliary system hellip

Ulcerative colitis

bull inflammatory bowel disease which predominantly affects the colon but also has extraintestinal manifestations

bull Clinically patients have chronic diarrhoea(sometimes bloody) associated with tenesmus pain and fever

Ischaemic colitis

bull inflammation of the colon secondary to vascular insufficiency and ischaemia

bull It sometimes considered under the same spectrum of intestinal ischeamia

bull The severity and consequences of the disease are highly variable

Clinical presentation

bull Presenting symptoms include abdominal pain and bloody

bull Tenderness may be present particularly of the left side of the abdomen

bull In severe cases where necrosis and perforation have occurred the signs and symptoms are those of peritonitis

Vasculitis

bull generalised inflammation of vessels Vasculidities carry a broad range of clinical presentations and as a whole can involve almost any organ system

Pathology

bull Some vasculitides are due to direct vessel injury from an infectious agent However a large proportion show evidence of immune complex related vessel wall injury

Classification

-Takayasu arteritis

-Wegener granulomatosis

-Henoch-Schoumlnlein purpura

-Churg-Strauss syndrome

Primary vasculitides -infection related

vasculitis

- SLE rheumatoid arthritis

-malignancy related vasculitis

Secondary vasculitides

Aetiology

bull Although LGIB can occur at any age specific disease processes are distinctive for different age groups and familiarity with this can help tailor the diagnostic workup

-adolescents and young adults inflammatory bowel diseases polyps Meckelrsquos diverticulum

-up to 60 years diverticula inflammatory bowel diseases malignancy

-older than 60 years arteriovenousmalformations diverticula malignancy

Clinical presentation

bull Acute bleeding is defined as bleeding of lt3 days duration resulting in instability of vital signs anaemia andor the need for blood transfusion

bull Chronic bleeding is defined as slow blood loss over a period of several days or longer presenting with symptoms of occult faecal blood intermittent melaena or scant hematochezia

bull LGIB usually is chronic and the bleeding ceases spontaneously (80)

Diverticular disease

bull Out-pouchings of bowel result in blind-ended diverticulae in communication with the lumen of the bowel

bull They most commonly occur within the sigmoid colon although they may be present throughout the bowel

Clinical presentation

bull The vast majority of people with diverticulosisare asymptomatic

bull Patients complain of intermittent left sided abdominal pain and frequent constipation Symptomatic presenting features of diverticular disease (ie presentation of complicated diverticulosis) includes

-diverticulitis

-GIT hemorrhage

Crohnrsquos disease

bull idiopathic inflammatory bowel disease characterised by widespread GIT involvement typically with skip lesions thereby its synonym regional enteritis and frequently systemic involvement

Clinical presentation

bull Clinical presentation is typically with chronic diarrhoea and recurrent abdominal pain

bull Alternatively patients may present with one of the many complications or extraintestinalmanifestations

-skin hellip

-joints hellip

-eyes hellip

-liver and biliary system hellip

Ulcerative colitis

bull inflammatory bowel disease which predominantly affects the colon but also has extraintestinal manifestations

bull Clinically patients have chronic diarrhoea(sometimes bloody) associated with tenesmus pain and fever

Ischaemic colitis

bull inflammation of the colon secondary to vascular insufficiency and ischaemia

bull It sometimes considered under the same spectrum of intestinal ischeamia

bull The severity and consequences of the disease are highly variable

Clinical presentation

bull Presenting symptoms include abdominal pain and bloody

bull Tenderness may be present particularly of the left side of the abdomen

bull In severe cases where necrosis and perforation have occurred the signs and symptoms are those of peritonitis

Vasculitis

bull generalised inflammation of vessels Vasculidities carry a broad range of clinical presentations and as a whole can involve almost any organ system

Pathology

bull Some vasculitides are due to direct vessel injury from an infectious agent However a large proportion show evidence of immune complex related vessel wall injury

Classification

-Takayasu arteritis

-Wegener granulomatosis

-Henoch-Schoumlnlein purpura

-Churg-Strauss syndrome

Primary vasculitides -infection related

vasculitis

- SLE rheumatoid arthritis

-malignancy related vasculitis

Secondary vasculitides

Clinical presentation

bull Acute bleeding is defined as bleeding of lt3 days duration resulting in instability of vital signs anaemia andor the need for blood transfusion

bull Chronic bleeding is defined as slow blood loss over a period of several days or longer presenting with symptoms of occult faecal blood intermittent melaena or scant hematochezia

bull LGIB usually is chronic and the bleeding ceases spontaneously (80)

Diverticular disease

bull Out-pouchings of bowel result in blind-ended diverticulae in communication with the lumen of the bowel

bull They most commonly occur within the sigmoid colon although they may be present throughout the bowel

Clinical presentation

bull The vast majority of people with diverticulosisare asymptomatic

bull Patients complain of intermittent left sided abdominal pain and frequent constipation Symptomatic presenting features of diverticular disease (ie presentation of complicated diverticulosis) includes

-diverticulitis

-GIT hemorrhage

Crohnrsquos disease

bull idiopathic inflammatory bowel disease characterised by widespread GIT involvement typically with skip lesions thereby its synonym regional enteritis and frequently systemic involvement

Clinical presentation

bull Clinical presentation is typically with chronic diarrhoea and recurrent abdominal pain

bull Alternatively patients may present with one of the many complications or extraintestinalmanifestations

-skin hellip

-joints hellip

-eyes hellip

-liver and biliary system hellip

Ulcerative colitis

bull inflammatory bowel disease which predominantly affects the colon but also has extraintestinal manifestations

bull Clinically patients have chronic diarrhoea(sometimes bloody) associated with tenesmus pain and fever

Ischaemic colitis

bull inflammation of the colon secondary to vascular insufficiency and ischaemia

bull It sometimes considered under the same spectrum of intestinal ischeamia

bull The severity and consequences of the disease are highly variable

Clinical presentation

bull Presenting symptoms include abdominal pain and bloody

bull Tenderness may be present particularly of the left side of the abdomen

bull In severe cases where necrosis and perforation have occurred the signs and symptoms are those of peritonitis

Vasculitis

bull generalised inflammation of vessels Vasculidities carry a broad range of clinical presentations and as a whole can involve almost any organ system

Pathology

bull Some vasculitides are due to direct vessel injury from an infectious agent However a large proportion show evidence of immune complex related vessel wall injury

Classification

-Takayasu arteritis

-Wegener granulomatosis

-Henoch-Schoumlnlein purpura

-Churg-Strauss syndrome

Primary vasculitides -infection related

vasculitis

- SLE rheumatoid arthritis

-malignancy related vasculitis

Secondary vasculitides

Diverticular disease

bull Out-pouchings of bowel result in blind-ended diverticulae in communication with the lumen of the bowel

bull They most commonly occur within the sigmoid colon although they may be present throughout the bowel

Clinical presentation

bull The vast majority of people with diverticulosisare asymptomatic

bull Patients complain of intermittent left sided abdominal pain and frequent constipation Symptomatic presenting features of diverticular disease (ie presentation of complicated diverticulosis) includes

-diverticulitis

-GIT hemorrhage

Crohnrsquos disease

bull idiopathic inflammatory bowel disease characterised by widespread GIT involvement typically with skip lesions thereby its synonym regional enteritis and frequently systemic involvement

Clinical presentation

bull Clinical presentation is typically with chronic diarrhoea and recurrent abdominal pain

bull Alternatively patients may present with one of the many complications or extraintestinalmanifestations

-skin hellip

-joints hellip

-eyes hellip

-liver and biliary system hellip

Ulcerative colitis

bull inflammatory bowel disease which predominantly affects the colon but also has extraintestinal manifestations

bull Clinically patients have chronic diarrhoea(sometimes bloody) associated with tenesmus pain and fever

Ischaemic colitis

bull inflammation of the colon secondary to vascular insufficiency and ischaemia

bull It sometimes considered under the same spectrum of intestinal ischeamia

bull The severity and consequences of the disease are highly variable

Clinical presentation

bull Presenting symptoms include abdominal pain and bloody

bull Tenderness may be present particularly of the left side of the abdomen

bull In severe cases where necrosis and perforation have occurred the signs and symptoms are those of peritonitis

Vasculitis

bull generalised inflammation of vessels Vasculidities carry a broad range of clinical presentations and as a whole can involve almost any organ system

Pathology

bull Some vasculitides are due to direct vessel injury from an infectious agent However a large proportion show evidence of immune complex related vessel wall injury

Classification

-Takayasu arteritis

-Wegener granulomatosis

-Henoch-Schoumlnlein purpura

-Churg-Strauss syndrome

Primary vasculitides -infection related

vasculitis

- SLE rheumatoid arthritis

-malignancy related vasculitis

Secondary vasculitides

Clinical presentation

bull The vast majority of people with diverticulosisare asymptomatic

bull Patients complain of intermittent left sided abdominal pain and frequent constipation Symptomatic presenting features of diverticular disease (ie presentation of complicated diverticulosis) includes

-diverticulitis

-GIT hemorrhage

Crohnrsquos disease

bull idiopathic inflammatory bowel disease characterised by widespread GIT involvement typically with skip lesions thereby its synonym regional enteritis and frequently systemic involvement

Clinical presentation

bull Clinical presentation is typically with chronic diarrhoea and recurrent abdominal pain

bull Alternatively patients may present with one of the many complications or extraintestinalmanifestations

-skin hellip

-joints hellip

-eyes hellip

-liver and biliary system hellip

Ulcerative colitis

bull inflammatory bowel disease which predominantly affects the colon but also has extraintestinal manifestations

bull Clinically patients have chronic diarrhoea(sometimes bloody) associated with tenesmus pain and fever

Ischaemic colitis

bull inflammation of the colon secondary to vascular insufficiency and ischaemia

bull It sometimes considered under the same spectrum of intestinal ischeamia

bull The severity and consequences of the disease are highly variable

Clinical presentation

bull Presenting symptoms include abdominal pain and bloody

bull Tenderness may be present particularly of the left side of the abdomen

bull In severe cases where necrosis and perforation have occurred the signs and symptoms are those of peritonitis

Vasculitis

bull generalised inflammation of vessels Vasculidities carry a broad range of clinical presentations and as a whole can involve almost any organ system

Pathology

bull Some vasculitides are due to direct vessel injury from an infectious agent However a large proportion show evidence of immune complex related vessel wall injury

Classification

-Takayasu arteritis

-Wegener granulomatosis

-Henoch-Schoumlnlein purpura

-Churg-Strauss syndrome

Primary vasculitides -infection related

vasculitis

- SLE rheumatoid arthritis

-malignancy related vasculitis

Secondary vasculitides

Crohnrsquos disease

bull idiopathic inflammatory bowel disease characterised by widespread GIT involvement typically with skip lesions thereby its synonym regional enteritis and frequently systemic involvement

Clinical presentation

bull Clinical presentation is typically with chronic diarrhoea and recurrent abdominal pain

bull Alternatively patients may present with one of the many complications or extraintestinalmanifestations

-skin hellip

-joints hellip

-eyes hellip

-liver and biliary system hellip

Ulcerative colitis

bull inflammatory bowel disease which predominantly affects the colon but also has extraintestinal manifestations

bull Clinically patients have chronic diarrhoea(sometimes bloody) associated with tenesmus pain and fever

Ischaemic colitis

bull inflammation of the colon secondary to vascular insufficiency and ischaemia

bull It sometimes considered under the same spectrum of intestinal ischeamia

bull The severity and consequences of the disease are highly variable

Clinical presentation

bull Presenting symptoms include abdominal pain and bloody

bull Tenderness may be present particularly of the left side of the abdomen

bull In severe cases where necrosis and perforation have occurred the signs and symptoms are those of peritonitis

Vasculitis

bull generalised inflammation of vessels Vasculidities carry a broad range of clinical presentations and as a whole can involve almost any organ system

Pathology

bull Some vasculitides are due to direct vessel injury from an infectious agent However a large proportion show evidence of immune complex related vessel wall injury

Classification

-Takayasu arteritis

-Wegener granulomatosis

-Henoch-Schoumlnlein purpura

-Churg-Strauss syndrome

Primary vasculitides -infection related

vasculitis

- SLE rheumatoid arthritis

-malignancy related vasculitis

Secondary vasculitides

Clinical presentation

bull Clinical presentation is typically with chronic diarrhoea and recurrent abdominal pain

bull Alternatively patients may present with one of the many complications or extraintestinalmanifestations

-skin hellip

-joints hellip

-eyes hellip

-liver and biliary system hellip

Ulcerative colitis

bull inflammatory bowel disease which predominantly affects the colon but also has extraintestinal manifestations

bull Clinically patients have chronic diarrhoea(sometimes bloody) associated with tenesmus pain and fever

Ischaemic colitis

bull inflammation of the colon secondary to vascular insufficiency and ischaemia

bull It sometimes considered under the same spectrum of intestinal ischeamia

bull The severity and consequences of the disease are highly variable

Clinical presentation

bull Presenting symptoms include abdominal pain and bloody

bull Tenderness may be present particularly of the left side of the abdomen

bull In severe cases where necrosis and perforation have occurred the signs and symptoms are those of peritonitis

Vasculitis

bull generalised inflammation of vessels Vasculidities carry a broad range of clinical presentations and as a whole can involve almost any organ system

Pathology

bull Some vasculitides are due to direct vessel injury from an infectious agent However a large proportion show evidence of immune complex related vessel wall injury

Classification

-Takayasu arteritis

-Wegener granulomatosis

-Henoch-Schoumlnlein purpura

-Churg-Strauss syndrome

Primary vasculitides -infection related

vasculitis

- SLE rheumatoid arthritis

-malignancy related vasculitis

Secondary vasculitides

Ulcerative colitis

bull inflammatory bowel disease which predominantly affects the colon but also has extraintestinal manifestations

bull Clinically patients have chronic diarrhoea(sometimes bloody) associated with tenesmus pain and fever

Ischaemic colitis

bull inflammation of the colon secondary to vascular insufficiency and ischaemia

bull It sometimes considered under the same spectrum of intestinal ischeamia

bull The severity and consequences of the disease are highly variable

Clinical presentation

bull Presenting symptoms include abdominal pain and bloody

bull Tenderness may be present particularly of the left side of the abdomen

bull In severe cases where necrosis and perforation have occurred the signs and symptoms are those of peritonitis

Vasculitis

bull generalised inflammation of vessels Vasculidities carry a broad range of clinical presentations and as a whole can involve almost any organ system

Pathology

bull Some vasculitides are due to direct vessel injury from an infectious agent However a large proportion show evidence of immune complex related vessel wall injury

Classification

-Takayasu arteritis

-Wegener granulomatosis

-Henoch-Schoumlnlein purpura

-Churg-Strauss syndrome

Primary vasculitides -infection related

vasculitis

- SLE rheumatoid arthritis

-malignancy related vasculitis

Secondary vasculitides

Ischaemic colitis

bull inflammation of the colon secondary to vascular insufficiency and ischaemia

bull It sometimes considered under the same spectrum of intestinal ischeamia

bull The severity and consequences of the disease are highly variable

Clinical presentation

bull Presenting symptoms include abdominal pain and bloody

bull Tenderness may be present particularly of the left side of the abdomen

bull In severe cases where necrosis and perforation have occurred the signs and symptoms are those of peritonitis

Vasculitis

bull generalised inflammation of vessels Vasculidities carry a broad range of clinical presentations and as a whole can involve almost any organ system

Pathology

bull Some vasculitides are due to direct vessel injury from an infectious agent However a large proportion show evidence of immune complex related vessel wall injury

Classification

-Takayasu arteritis

-Wegener granulomatosis

-Henoch-Schoumlnlein purpura

-Churg-Strauss syndrome

Primary vasculitides -infection related

vasculitis

- SLE rheumatoid arthritis

-malignancy related vasculitis

Secondary vasculitides

Clinical presentation

bull Presenting symptoms include abdominal pain and bloody

bull Tenderness may be present particularly of the left side of the abdomen

bull In severe cases where necrosis and perforation have occurred the signs and symptoms are those of peritonitis

Vasculitis

bull generalised inflammation of vessels Vasculidities carry a broad range of clinical presentations and as a whole can involve almost any organ system

Pathology

bull Some vasculitides are due to direct vessel injury from an infectious agent However a large proportion show evidence of immune complex related vessel wall injury

Classification

-Takayasu arteritis

-Wegener granulomatosis

-Henoch-Schoumlnlein purpura

-Churg-Strauss syndrome

Primary vasculitides -infection related

vasculitis

- SLE rheumatoid arthritis

-malignancy related vasculitis

Secondary vasculitides

Vasculitis

bull generalised inflammation of vessels Vasculidities carry a broad range of clinical presentations and as a whole can involve almost any organ system

Pathology

bull Some vasculitides are due to direct vessel injury from an infectious agent However a large proportion show evidence of immune complex related vessel wall injury

Classification

-Takayasu arteritis

-Wegener granulomatosis

-Henoch-Schoumlnlein purpura

-Churg-Strauss syndrome

Primary vasculitides -infection related

vasculitis

- SLE rheumatoid arthritis

-malignancy related vasculitis

Secondary vasculitides

Pathology

bull Some vasculitides are due to direct vessel injury from an infectious agent However a large proportion show evidence of immune complex related vessel wall injury

Classification

-Takayasu arteritis

-Wegener granulomatosis

-Henoch-Schoumlnlein purpura

-Churg-Strauss syndrome

Primary vasculitides -infection related

vasculitis

- SLE rheumatoid arthritis

-malignancy related vasculitis

Secondary vasculitides

Classification

-Takayasu arteritis

-Wegener granulomatosis

-Henoch-Schoumlnlein purpura

-Churg-Strauss syndrome

Primary vasculitides -infection related

vasculitis

- SLE rheumatoid arthritis

-malignancy related vasculitis

Secondary vasculitides

Portal hypertensive gastropathy enteropathy colopathy

bull In portal hypertension chronic portal venous congestion leads to dilatation and ectasia of the submucosal vessels in the stomach (portal hypertensive gastropathy) small bowel (portal hypertensive enteropathy) and or large bowel (portal hypertensive colopathy)

bull This may result in upper or lower gastrointestinal bleeding even in the absence of varices

bull The bleeding may be acute or chronic but is most commonly chronic low-grade GI blood loss associated with an iron-deficiency anaemia

Fluoroscopy

bull Barium studies may show thickening of the mucosal folds and nodular filling defects

CT

there may be bowel wall

thickening and hyperaemia

which can mimic

enterocolitis

Meckel diverticulum

bull a type of congenital intestinal diverticulumthat occurs around the distal ileum

bull It is considered the most common structural congenital anomaly of the gastrointestinal tract

Clinical presentation

bull A large proportion of individuals remain asymptomatic although up to a third of them may experience clinical symptoms

bull Clinical presentation includes-pain-malaenahaematochezia-Small bowel obstruction-Intussuscption-volvulus-perforation-Littre hernia

Angiodysplasia

bull most common vascular lesion of the gastrointestinal tract after diverticulosis and this condition may be asymptomatic or it may cause gastrointestinal (GI) bleedingThe vessel walls are thin with little or no smooth muscle and the vessels are ectatic and thin

bull 77of angiodysplasias are located in the cecum and ascending colon

bull 15 are located in the jejunum and ileum

bull 8 is distributed throughout the alimentary tract

Clinical presentation

bull maroon-colored stool melena or hematochezia bull Bleeding is usually low grade but it can be

massive in approximately 15 of patients bull In 20-25 of bleeding episodes only tarry stools

are passedbull Iron deficiency anemia and stools that are

intermittently positive for occult blood can be the only manifestations of angiodysplasia in 10-15 of patients

bull Bleeding stops spontaneously in greater than 90 of cases but is often recurrent

Cancer colon

bull Most cases of colon cancer begin as small noncancerous (benign) clumps of cells called adenomatous polyps Over time some of these polyps become colon cancers

Clinical presentation

bull Bleeding per rectum

bull Alternating bowel habits

bull Discharge

bull Tenesmus

bull Intestinal obstruction

bull Mass

bull Systemic manifestations

polyps

bull Inflammatory

bull Hamartomatous

bull Neoplastic

bull Hyperplastic

Neoplastic polyps

Tubular

bull gt 85

bull Male

bull Multiple

bull Pedunculated

bull Malignancy 5

Villous

bull 15

bull Female

bull Single

bull Sessile

bull Malignancy 30

Clinical presentation

bull Age

bull Bleeding

bull Discharge

bull Colics

Reference

bull httpradiopaediaorgarticleslower-gastrointestinal-bleeding1 Ghassemi KA Jensen DM Lower GI bleeding epidemiology and management Curr

Gastroenterol Rep 201315 (7) 333 doi101007s11894-013-0333-5 - Free text at pubmed - Pubmed citation

2 Raphaeli T Menon R Current treatment of lower gastrointestinal hemorrhage ClinColon Rectal Surg 201225 (04) 219-27 doi101055s-0032-1329393 - Free text at pubmed - Pubmed citation

3 Jang BI Lower Gastrointestinal Bleeding Is Urgent Colonoscopy Necessary for All Hematochezia Clin Endosc 201346 (5) 476-479doi105946ce2013465476 -Free text at pubmed - Pubmed citation

4 Mariani G Pauwels EK AlSharif A et-al Radionuclide evaluation of the lower gastrointestinal tract J Nucl Med 200849 (5) 776-87doi102967jnumed107040113 - Pubmed citation

5 Geffroy Y Rodallec MH Boulay-Coletta I et-al Multidetector CT angiography in acute gastrointestinal bleeding why when and how Radiographics 201131 (3) E35-46 doi101148rg313105206 - Pubmed citation

Fluoroscopy

bull Barium studies may show thickening of the mucosal folds and nodular filling defects

CT

there may be bowel wall

thickening and hyperaemia

which can mimic

enterocolitis

Meckel diverticulum

bull a type of congenital intestinal diverticulumthat occurs around the distal ileum

bull It is considered the most common structural congenital anomaly of the gastrointestinal tract

Clinical presentation

bull A large proportion of individuals remain asymptomatic although up to a third of them may experience clinical symptoms

bull Clinical presentation includes-pain-malaenahaematochezia-Small bowel obstruction-Intussuscption-volvulus-perforation-Littre hernia

Angiodysplasia

bull most common vascular lesion of the gastrointestinal tract after diverticulosis and this condition may be asymptomatic or it may cause gastrointestinal (GI) bleedingThe vessel walls are thin with little or no smooth muscle and the vessels are ectatic and thin

bull 77of angiodysplasias are located in the cecum and ascending colon

bull 15 are located in the jejunum and ileum

bull 8 is distributed throughout the alimentary tract

Clinical presentation

bull maroon-colored stool melena or hematochezia bull Bleeding is usually low grade but it can be

massive in approximately 15 of patients bull In 20-25 of bleeding episodes only tarry stools

are passedbull Iron deficiency anemia and stools that are

intermittently positive for occult blood can be the only manifestations of angiodysplasia in 10-15 of patients

bull Bleeding stops spontaneously in greater than 90 of cases but is often recurrent

Cancer colon

bull Most cases of colon cancer begin as small noncancerous (benign) clumps of cells called adenomatous polyps Over time some of these polyps become colon cancers

Clinical presentation

bull Bleeding per rectum

bull Alternating bowel habits

bull Discharge

bull Tenesmus

bull Intestinal obstruction

bull Mass

bull Systemic manifestations

polyps

bull Inflammatory

bull Hamartomatous

bull Neoplastic

bull Hyperplastic

Neoplastic polyps

Tubular

bull gt 85

bull Male

bull Multiple

bull Pedunculated

bull Malignancy 5

Villous

bull 15

bull Female

bull Single

bull Sessile

bull Malignancy 30

Clinical presentation

bull Age

bull Bleeding

bull Discharge

bull Colics

Reference

bull httpradiopaediaorgarticleslower-gastrointestinal-bleeding1 Ghassemi KA Jensen DM Lower GI bleeding epidemiology and management Curr

Gastroenterol Rep 201315 (7) 333 doi101007s11894-013-0333-5 - Free text at pubmed - Pubmed citation

2 Raphaeli T Menon R Current treatment of lower gastrointestinal hemorrhage ClinColon Rectal Surg 201225 (04) 219-27 doi101055s-0032-1329393 - Free text at pubmed - Pubmed citation

3 Jang BI Lower Gastrointestinal Bleeding Is Urgent Colonoscopy Necessary for All Hematochezia Clin Endosc 201346 (5) 476-479doi105946ce2013465476 -Free text at pubmed - Pubmed citation

4 Mariani G Pauwels EK AlSharif A et-al Radionuclide evaluation of the lower gastrointestinal tract J Nucl Med 200849 (5) 776-87doi102967jnumed107040113 - Pubmed citation

5 Geffroy Y Rodallec MH Boulay-Coletta I et-al Multidetector CT angiography in acute gastrointestinal bleeding why when and how Radiographics 201131 (3) E35-46 doi101148rg313105206 - Pubmed citation

CT

there may be bowel wall

thickening and hyperaemia

which can mimic

enterocolitis

Meckel diverticulum

bull a type of congenital intestinal diverticulumthat occurs around the distal ileum

bull It is considered the most common structural congenital anomaly of the gastrointestinal tract

Clinical presentation

bull A large proportion of individuals remain asymptomatic although up to a third of them may experience clinical symptoms

bull Clinical presentation includes-pain-malaenahaematochezia-Small bowel obstruction-Intussuscption-volvulus-perforation-Littre hernia

Angiodysplasia

bull most common vascular lesion of the gastrointestinal tract after diverticulosis and this condition may be asymptomatic or it may cause gastrointestinal (GI) bleedingThe vessel walls are thin with little or no smooth muscle and the vessels are ectatic and thin

bull 77of angiodysplasias are located in the cecum and ascending colon

bull 15 are located in the jejunum and ileum

bull 8 is distributed throughout the alimentary tract

Clinical presentation

bull maroon-colored stool melena or hematochezia bull Bleeding is usually low grade but it can be

massive in approximately 15 of patients bull In 20-25 of bleeding episodes only tarry stools

are passedbull Iron deficiency anemia and stools that are

intermittently positive for occult blood can be the only manifestations of angiodysplasia in 10-15 of patients

bull Bleeding stops spontaneously in greater than 90 of cases but is often recurrent

Cancer colon

bull Most cases of colon cancer begin as small noncancerous (benign) clumps of cells called adenomatous polyps Over time some of these polyps become colon cancers

Clinical presentation

bull Bleeding per rectum

bull Alternating bowel habits

bull Discharge

bull Tenesmus

bull Intestinal obstruction

bull Mass

bull Systemic manifestations

polyps

bull Inflammatory

bull Hamartomatous

bull Neoplastic

bull Hyperplastic

Neoplastic polyps

Tubular

bull gt 85

bull Male

bull Multiple

bull Pedunculated

bull Malignancy 5

Villous

bull 15

bull Female

bull Single

bull Sessile

bull Malignancy 30

Clinical presentation

bull Age

bull Bleeding

bull Discharge

bull Colics

Reference

bull httpradiopaediaorgarticleslower-gastrointestinal-bleeding1 Ghassemi KA Jensen DM Lower GI bleeding epidemiology and management Curr

Gastroenterol Rep 201315 (7) 333 doi101007s11894-013-0333-5 - Free text at pubmed - Pubmed citation

2 Raphaeli T Menon R Current treatment of lower gastrointestinal hemorrhage ClinColon Rectal Surg 201225 (04) 219-27 doi101055s-0032-1329393 - Free text at pubmed - Pubmed citation

3 Jang BI Lower Gastrointestinal Bleeding Is Urgent Colonoscopy Necessary for All Hematochezia Clin Endosc 201346 (5) 476-479doi105946ce2013465476 -Free text at pubmed - Pubmed citation

4 Mariani G Pauwels EK AlSharif A et-al Radionuclide evaluation of the lower gastrointestinal tract J Nucl Med 200849 (5) 776-87doi102967jnumed107040113 - Pubmed citation

5 Geffroy Y Rodallec MH Boulay-Coletta I et-al Multidetector CT angiography in acute gastrointestinal bleeding why when and how Radiographics 201131 (3) E35-46 doi101148rg313105206 - Pubmed citation

Meckel diverticulum

bull a type of congenital intestinal diverticulumthat occurs around the distal ileum

bull It is considered the most common structural congenital anomaly of the gastrointestinal tract

Clinical presentation

bull A large proportion of individuals remain asymptomatic although up to a third of them may experience clinical symptoms

bull Clinical presentation includes-pain-malaenahaematochezia-Small bowel obstruction-Intussuscption-volvulus-perforation-Littre hernia

Angiodysplasia

bull most common vascular lesion of the gastrointestinal tract after diverticulosis and this condition may be asymptomatic or it may cause gastrointestinal (GI) bleedingThe vessel walls are thin with little or no smooth muscle and the vessels are ectatic and thin

bull 77of angiodysplasias are located in the cecum and ascending colon

bull 15 are located in the jejunum and ileum

bull 8 is distributed throughout the alimentary tract

Clinical presentation

bull maroon-colored stool melena or hematochezia bull Bleeding is usually low grade but it can be

massive in approximately 15 of patients bull In 20-25 of bleeding episodes only tarry stools

are passedbull Iron deficiency anemia and stools that are

intermittently positive for occult blood can be the only manifestations of angiodysplasia in 10-15 of patients

bull Bleeding stops spontaneously in greater than 90 of cases but is often recurrent

Cancer colon

bull Most cases of colon cancer begin as small noncancerous (benign) clumps of cells called adenomatous polyps Over time some of these polyps become colon cancers

Clinical presentation

bull Bleeding per rectum

bull Alternating bowel habits

bull Discharge

bull Tenesmus

bull Intestinal obstruction

bull Mass

bull Systemic manifestations

polyps

bull Inflammatory

bull Hamartomatous

bull Neoplastic

bull Hyperplastic

Neoplastic polyps

Tubular

bull gt 85

bull Male

bull Multiple

bull Pedunculated

bull Malignancy 5

Villous

bull 15

bull Female

bull Single

bull Sessile

bull Malignancy 30

Clinical presentation

bull Age

bull Bleeding

bull Discharge

bull Colics

Reference

bull httpradiopaediaorgarticleslower-gastrointestinal-bleeding1 Ghassemi KA Jensen DM Lower GI bleeding epidemiology and management Curr

Gastroenterol Rep 201315 (7) 333 doi101007s11894-013-0333-5 - Free text at pubmed - Pubmed citation

2 Raphaeli T Menon R Current treatment of lower gastrointestinal hemorrhage ClinColon Rectal Surg 201225 (04) 219-27 doi101055s-0032-1329393 - Free text at pubmed - Pubmed citation

3 Jang BI Lower Gastrointestinal Bleeding Is Urgent Colonoscopy Necessary for All Hematochezia Clin Endosc 201346 (5) 476-479doi105946ce2013465476 -Free text at pubmed - Pubmed citation

4 Mariani G Pauwels EK AlSharif A et-al Radionuclide evaluation of the lower gastrointestinal tract J Nucl Med 200849 (5) 776-87doi102967jnumed107040113 - Pubmed citation

5 Geffroy Y Rodallec MH Boulay-Coletta I et-al Multidetector CT angiography in acute gastrointestinal bleeding why when and how Radiographics 201131 (3) E35-46 doi101148rg313105206 - Pubmed citation

Clinical presentation

bull A large proportion of individuals remain asymptomatic although up to a third of them may experience clinical symptoms

bull Clinical presentation includes-pain-malaenahaematochezia-Small bowel obstruction-Intussuscption-volvulus-perforation-Littre hernia

Angiodysplasia

bull most common vascular lesion of the gastrointestinal tract after diverticulosis and this condition may be asymptomatic or it may cause gastrointestinal (GI) bleedingThe vessel walls are thin with little or no smooth muscle and the vessels are ectatic and thin

bull 77of angiodysplasias are located in the cecum and ascending colon

bull 15 are located in the jejunum and ileum

bull 8 is distributed throughout the alimentary tract

Clinical presentation

bull maroon-colored stool melena or hematochezia bull Bleeding is usually low grade but it can be

massive in approximately 15 of patients bull In 20-25 of bleeding episodes only tarry stools

are passedbull Iron deficiency anemia and stools that are

intermittently positive for occult blood can be the only manifestations of angiodysplasia in 10-15 of patients

bull Bleeding stops spontaneously in greater than 90 of cases but is often recurrent

Cancer colon

bull Most cases of colon cancer begin as small noncancerous (benign) clumps of cells called adenomatous polyps Over time some of these polyps become colon cancers

Clinical presentation

bull Bleeding per rectum

bull Alternating bowel habits

bull Discharge

bull Tenesmus

bull Intestinal obstruction

bull Mass

bull Systemic manifestations

polyps

bull Inflammatory

bull Hamartomatous

bull Neoplastic

bull Hyperplastic

Neoplastic polyps

Tubular

bull gt 85

bull Male

bull Multiple

bull Pedunculated

bull Malignancy 5

Villous

bull 15

bull Female

bull Single

bull Sessile

bull Malignancy 30

Clinical presentation

bull Age

bull Bleeding

bull Discharge

bull Colics

Reference

bull httpradiopaediaorgarticleslower-gastrointestinal-bleeding1 Ghassemi KA Jensen DM Lower GI bleeding epidemiology and management Curr

Gastroenterol Rep 201315 (7) 333 doi101007s11894-013-0333-5 - Free text at pubmed - Pubmed citation

2 Raphaeli T Menon R Current treatment of lower gastrointestinal hemorrhage ClinColon Rectal Surg 201225 (04) 219-27 doi101055s-0032-1329393 - Free text at pubmed - Pubmed citation

3 Jang BI Lower Gastrointestinal Bleeding Is Urgent Colonoscopy Necessary for All Hematochezia Clin Endosc 201346 (5) 476-479doi105946ce2013465476 -Free text at pubmed - Pubmed citation

4 Mariani G Pauwels EK AlSharif A et-al Radionuclide evaluation of the lower gastrointestinal tract J Nucl Med 200849 (5) 776-87doi102967jnumed107040113 - Pubmed citation

5 Geffroy Y Rodallec MH Boulay-Coletta I et-al Multidetector CT angiography in acute gastrointestinal bleeding why when and how Radiographics 201131 (3) E35-46 doi101148rg313105206 - Pubmed citation

Angiodysplasia

bull most common vascular lesion of the gastrointestinal tract after diverticulosis and this condition may be asymptomatic or it may cause gastrointestinal (GI) bleedingThe vessel walls are thin with little or no smooth muscle and the vessels are ectatic and thin

bull 77of angiodysplasias are located in the cecum and ascending colon

bull 15 are located in the jejunum and ileum

bull 8 is distributed throughout the alimentary tract

Clinical presentation

bull maroon-colored stool melena or hematochezia bull Bleeding is usually low grade but it can be

massive in approximately 15 of patients bull In 20-25 of bleeding episodes only tarry stools

are passedbull Iron deficiency anemia and stools that are

intermittently positive for occult blood can be the only manifestations of angiodysplasia in 10-15 of patients

bull Bleeding stops spontaneously in greater than 90 of cases but is often recurrent

Cancer colon

bull Most cases of colon cancer begin as small noncancerous (benign) clumps of cells called adenomatous polyps Over time some of these polyps become colon cancers

Clinical presentation

bull Bleeding per rectum

bull Alternating bowel habits

bull Discharge

bull Tenesmus

bull Intestinal obstruction

bull Mass

bull Systemic manifestations

polyps

bull Inflammatory

bull Hamartomatous

bull Neoplastic

bull Hyperplastic

Neoplastic polyps

Tubular

bull gt 85

bull Male

bull Multiple

bull Pedunculated

bull Malignancy 5

Villous

bull 15

bull Female

bull Single

bull Sessile

bull Malignancy 30

Clinical presentation

bull Age

bull Bleeding

bull Discharge

bull Colics

Reference

bull httpradiopaediaorgarticleslower-gastrointestinal-bleeding1 Ghassemi KA Jensen DM Lower GI bleeding epidemiology and management Curr

Gastroenterol Rep 201315 (7) 333 doi101007s11894-013-0333-5 - Free text at pubmed - Pubmed citation

2 Raphaeli T Menon R Current treatment of lower gastrointestinal hemorrhage ClinColon Rectal Surg 201225 (04) 219-27 doi101055s-0032-1329393 - Free text at pubmed - Pubmed citation

3 Jang BI Lower Gastrointestinal Bleeding Is Urgent Colonoscopy Necessary for All Hematochezia Clin Endosc 201346 (5) 476-479doi105946ce2013465476 -Free text at pubmed - Pubmed citation

4 Mariani G Pauwels EK AlSharif A et-al Radionuclide evaluation of the lower gastrointestinal tract J Nucl Med 200849 (5) 776-87doi102967jnumed107040113 - Pubmed citation

5 Geffroy Y Rodallec MH Boulay-Coletta I et-al Multidetector CT angiography in acute gastrointestinal bleeding why when and how Radiographics 201131 (3) E35-46 doi101148rg313105206 - Pubmed citation

bull 77of angiodysplasias are located in the cecum and ascending colon

bull 15 are located in the jejunum and ileum

bull 8 is distributed throughout the alimentary tract

Clinical presentation

bull maroon-colored stool melena or hematochezia bull Bleeding is usually low grade but it can be

massive in approximately 15 of patients bull In 20-25 of bleeding episodes only tarry stools

are passedbull Iron deficiency anemia and stools that are

intermittently positive for occult blood can be the only manifestations of angiodysplasia in 10-15 of patients

bull Bleeding stops spontaneously in greater than 90 of cases but is often recurrent

Cancer colon

bull Most cases of colon cancer begin as small noncancerous (benign) clumps of cells called adenomatous polyps Over time some of these polyps become colon cancers

Clinical presentation

bull Bleeding per rectum

bull Alternating bowel habits

bull Discharge

bull Tenesmus

bull Intestinal obstruction

bull Mass

bull Systemic manifestations

polyps

bull Inflammatory

bull Hamartomatous

bull Neoplastic

bull Hyperplastic

Neoplastic polyps

Tubular

bull gt 85

bull Male

bull Multiple

bull Pedunculated

bull Malignancy 5

Villous

bull 15

bull Female

bull Single

bull Sessile

bull Malignancy 30

Clinical presentation

bull Age

bull Bleeding

bull Discharge

bull Colics

Reference

bull httpradiopaediaorgarticleslower-gastrointestinal-bleeding1 Ghassemi KA Jensen DM Lower GI bleeding epidemiology and management Curr

Gastroenterol Rep 201315 (7) 333 doi101007s11894-013-0333-5 - Free text at pubmed - Pubmed citation

2 Raphaeli T Menon R Current treatment of lower gastrointestinal hemorrhage ClinColon Rectal Surg 201225 (04) 219-27 doi101055s-0032-1329393 - Free text at pubmed - Pubmed citation

3 Jang BI Lower Gastrointestinal Bleeding Is Urgent Colonoscopy Necessary for All Hematochezia Clin Endosc 201346 (5) 476-479doi105946ce2013465476 -Free text at pubmed - Pubmed citation

4 Mariani G Pauwels EK AlSharif A et-al Radionuclide evaluation of the lower gastrointestinal tract J Nucl Med 200849 (5) 776-87doi102967jnumed107040113 - Pubmed citation

5 Geffroy Y Rodallec MH Boulay-Coletta I et-al Multidetector CT angiography in acute gastrointestinal bleeding why when and how Radiographics 201131 (3) E35-46 doi101148rg313105206 - Pubmed citation

Clinical presentation

bull maroon-colored stool melena or hematochezia bull Bleeding is usually low grade but it can be

massive in approximately 15 of patients bull In 20-25 of bleeding episodes only tarry stools

are passedbull Iron deficiency anemia and stools that are

intermittently positive for occult blood can be the only manifestations of angiodysplasia in 10-15 of patients

bull Bleeding stops spontaneously in greater than 90 of cases but is often recurrent

Cancer colon

bull Most cases of colon cancer begin as small noncancerous (benign) clumps of cells called adenomatous polyps Over time some of these polyps become colon cancers

Clinical presentation

bull Bleeding per rectum

bull Alternating bowel habits

bull Discharge

bull Tenesmus

bull Intestinal obstruction

bull Mass

bull Systemic manifestations

polyps

bull Inflammatory

bull Hamartomatous

bull Neoplastic

bull Hyperplastic

Neoplastic polyps

Tubular

bull gt 85

bull Male

bull Multiple

bull Pedunculated

bull Malignancy 5

Villous

bull 15

bull Female

bull Single

bull Sessile

bull Malignancy 30

Clinical presentation

bull Age

bull Bleeding

bull Discharge

bull Colics

Reference

bull httpradiopaediaorgarticleslower-gastrointestinal-bleeding1 Ghassemi KA Jensen DM Lower GI bleeding epidemiology and management Curr

Gastroenterol Rep 201315 (7) 333 doi101007s11894-013-0333-5 - Free text at pubmed - Pubmed citation

2 Raphaeli T Menon R Current treatment of lower gastrointestinal hemorrhage ClinColon Rectal Surg 201225 (04) 219-27 doi101055s-0032-1329393 - Free text at pubmed - Pubmed citation

3 Jang BI Lower Gastrointestinal Bleeding Is Urgent Colonoscopy Necessary for All Hematochezia Clin Endosc 201346 (5) 476-479doi105946ce2013465476 -Free text at pubmed - Pubmed citation

4 Mariani G Pauwels EK AlSharif A et-al Radionuclide evaluation of the lower gastrointestinal tract J Nucl Med 200849 (5) 776-87doi102967jnumed107040113 - Pubmed citation

5 Geffroy Y Rodallec MH Boulay-Coletta I et-al Multidetector CT angiography in acute gastrointestinal bleeding why when and how Radiographics 201131 (3) E35-46 doi101148rg313105206 - Pubmed citation

Cancer colon

bull Most cases of colon cancer begin as small noncancerous (benign) clumps of cells called adenomatous polyps Over time some of these polyps become colon cancers

Clinical presentation

bull Bleeding per rectum

bull Alternating bowel habits

bull Discharge

bull Tenesmus

bull Intestinal obstruction

bull Mass

bull Systemic manifestations

polyps

bull Inflammatory

bull Hamartomatous

bull Neoplastic

bull Hyperplastic

Neoplastic polyps

Tubular

bull gt 85

bull Male

bull Multiple

bull Pedunculated

bull Malignancy 5

Villous

bull 15

bull Female

bull Single

bull Sessile

bull Malignancy 30

Clinical presentation

bull Age

bull Bleeding

bull Discharge

bull Colics

Reference

bull httpradiopaediaorgarticleslower-gastrointestinal-bleeding1 Ghassemi KA Jensen DM Lower GI bleeding epidemiology and management Curr

Gastroenterol Rep 201315 (7) 333 doi101007s11894-013-0333-5 - Free text at pubmed - Pubmed citation

2 Raphaeli T Menon R Current treatment of lower gastrointestinal hemorrhage ClinColon Rectal Surg 201225 (04) 219-27 doi101055s-0032-1329393 - Free text at pubmed - Pubmed citation

3 Jang BI Lower Gastrointestinal Bleeding Is Urgent Colonoscopy Necessary for All Hematochezia Clin Endosc 201346 (5) 476-479doi105946ce2013465476 -Free text at pubmed - Pubmed citation

4 Mariani G Pauwels EK AlSharif A et-al Radionuclide evaluation of the lower gastrointestinal tract J Nucl Med 200849 (5) 776-87doi102967jnumed107040113 - Pubmed citation

5 Geffroy Y Rodallec MH Boulay-Coletta I et-al Multidetector CT angiography in acute gastrointestinal bleeding why when and how Radiographics 201131 (3) E35-46 doi101148rg313105206 - Pubmed citation

Clinical presentation

bull Bleeding per rectum

bull Alternating bowel habits

bull Discharge

bull Tenesmus

bull Intestinal obstruction

bull Mass

bull Systemic manifestations

polyps

bull Inflammatory

bull Hamartomatous

bull Neoplastic

bull Hyperplastic

Neoplastic polyps

Tubular

bull gt 85

bull Male

bull Multiple

bull Pedunculated

bull Malignancy 5

Villous

bull 15

bull Female

bull Single

bull Sessile

bull Malignancy 30

Clinical presentation

bull Age

bull Bleeding

bull Discharge

bull Colics

Reference

bull httpradiopaediaorgarticleslower-gastrointestinal-bleeding1 Ghassemi KA Jensen DM Lower GI bleeding epidemiology and management Curr

Gastroenterol Rep 201315 (7) 333 doi101007s11894-013-0333-5 - Free text at pubmed - Pubmed citation

2 Raphaeli T Menon R Current treatment of lower gastrointestinal hemorrhage ClinColon Rectal Surg 201225 (04) 219-27 doi101055s-0032-1329393 - Free text at pubmed - Pubmed citation

3 Jang BI Lower Gastrointestinal Bleeding Is Urgent Colonoscopy Necessary for All Hematochezia Clin Endosc 201346 (5) 476-479doi105946ce2013465476 -Free text at pubmed - Pubmed citation

4 Mariani G Pauwels EK AlSharif A et-al Radionuclide evaluation of the lower gastrointestinal tract J Nucl Med 200849 (5) 776-87doi102967jnumed107040113 - Pubmed citation

5 Geffroy Y Rodallec MH Boulay-Coletta I et-al Multidetector CT angiography in acute gastrointestinal bleeding why when and how Radiographics 201131 (3) E35-46 doi101148rg313105206 - Pubmed citation

polyps

bull Inflammatory

bull Hamartomatous

bull Neoplastic

bull Hyperplastic

Neoplastic polyps

Tubular

bull gt 85

bull Male

bull Multiple

bull Pedunculated

bull Malignancy 5

Villous

bull 15

bull Female

bull Single

bull Sessile

bull Malignancy 30

Clinical presentation

bull Age

bull Bleeding

bull Discharge

bull Colics

Reference

bull httpradiopaediaorgarticleslower-gastrointestinal-bleeding1 Ghassemi KA Jensen DM Lower GI bleeding epidemiology and management Curr

Gastroenterol Rep 201315 (7) 333 doi101007s11894-013-0333-5 - Free text at pubmed - Pubmed citation

2 Raphaeli T Menon R Current treatment of lower gastrointestinal hemorrhage ClinColon Rectal Surg 201225 (04) 219-27 doi101055s-0032-1329393 - Free text at pubmed - Pubmed citation

3 Jang BI Lower Gastrointestinal Bleeding Is Urgent Colonoscopy Necessary for All Hematochezia Clin Endosc 201346 (5) 476-479doi105946ce2013465476 -Free text at pubmed - Pubmed citation

4 Mariani G Pauwels EK AlSharif A et-al Radionuclide evaluation of the lower gastrointestinal tract J Nucl Med 200849 (5) 776-87doi102967jnumed107040113 - Pubmed citation

5 Geffroy Y Rodallec MH Boulay-Coletta I et-al Multidetector CT angiography in acute gastrointestinal bleeding why when and how Radiographics 201131 (3) E35-46 doi101148rg313105206 - Pubmed citation

Neoplastic polyps

Tubular

bull gt 85

bull Male

bull Multiple

bull Pedunculated

bull Malignancy 5

Villous

bull 15

bull Female

bull Single

bull Sessile

bull Malignancy 30

Clinical presentation

bull Age

bull Bleeding

bull Discharge

bull Colics

Reference

bull httpradiopaediaorgarticleslower-gastrointestinal-bleeding1 Ghassemi KA Jensen DM Lower GI bleeding epidemiology and management Curr

Gastroenterol Rep 201315 (7) 333 doi101007s11894-013-0333-5 - Free text at pubmed - Pubmed citation

2 Raphaeli T Menon R Current treatment of lower gastrointestinal hemorrhage ClinColon Rectal Surg 201225 (04) 219-27 doi101055s-0032-1329393 - Free text at pubmed - Pubmed citation

3 Jang BI Lower Gastrointestinal Bleeding Is Urgent Colonoscopy Necessary for All Hematochezia Clin Endosc 201346 (5) 476-479doi105946ce2013465476 -Free text at pubmed - Pubmed citation

4 Mariani G Pauwels EK AlSharif A et-al Radionuclide evaluation of the lower gastrointestinal tract J Nucl Med 200849 (5) 776-87doi102967jnumed107040113 - Pubmed citation

5 Geffroy Y Rodallec MH Boulay-Coletta I et-al Multidetector CT angiography in acute gastrointestinal bleeding why when and how Radiographics 201131 (3) E35-46 doi101148rg313105206 - Pubmed citation

Clinical presentation

bull Age

bull Bleeding

bull Discharge

bull Colics

Reference

bull httpradiopaediaorgarticleslower-gastrointestinal-bleeding1 Ghassemi KA Jensen DM Lower GI bleeding epidemiology and management Curr

Gastroenterol Rep 201315 (7) 333 doi101007s11894-013-0333-5 - Free text at pubmed - Pubmed citation

2 Raphaeli T Menon R Current treatment of lower gastrointestinal hemorrhage ClinColon Rectal Surg 201225 (04) 219-27 doi101055s-0032-1329393 - Free text at pubmed - Pubmed citation

3 Jang BI Lower Gastrointestinal Bleeding Is Urgent Colonoscopy Necessary for All Hematochezia Clin Endosc 201346 (5) 476-479doi105946ce2013465476 -Free text at pubmed - Pubmed citation

4 Mariani G Pauwels EK AlSharif A et-al Radionuclide evaluation of the lower gastrointestinal tract J Nucl Med 200849 (5) 776-87doi102967jnumed107040113 - Pubmed citation

5 Geffroy Y Rodallec MH Boulay-Coletta I et-al Multidetector CT angiography in acute gastrointestinal bleeding why when and how Radiographics 201131 (3) E35-46 doi101148rg313105206 - Pubmed citation

Reference

bull httpradiopaediaorgarticleslower-gastrointestinal-bleeding1 Ghassemi KA Jensen DM Lower GI bleeding epidemiology and management Curr

Gastroenterol Rep 201315 (7) 333 doi101007s11894-013-0333-5 - Free text at pubmed - Pubmed citation

2 Raphaeli T Menon R Current treatment of lower gastrointestinal hemorrhage ClinColon Rectal Surg 201225 (04) 219-27 doi101055s-0032-1329393 - Free text at pubmed - Pubmed citation

3 Jang BI Lower Gastrointestinal Bleeding Is Urgent Colonoscopy Necessary for All Hematochezia Clin Endosc 201346 (5) 476-479doi105946ce2013465476 -Free text at pubmed - Pubmed citation

4 Mariani G Pauwels EK AlSharif A et-al Radionuclide evaluation of the lower gastrointestinal tract J Nucl Med 200849 (5) 776-87doi102967jnumed107040113 - Pubmed citation

5 Geffroy Y Rodallec MH Boulay-Coletta I et-al Multidetector CT angiography in acute gastrointestinal bleeding why when and how Radiographics 201131 (3) E35-46 doi101148rg313105206 - Pubmed citation