DiverticuliThe timing and type of gastrointestinal investigations depend primarily on the type of LGI bleeding.

There are three clinical presentations of LGI bleeding to consider, as follow:

• Hemoccult (Beckman Coulter Inc, USA)-positive stools, found as part of an outpatient investigation or screening examination. These patients tend to have chronic blood loss, which can be investigated on an outpatient basis. Sometimes both UGI and LGI tract investigations are required to clarify the source of bleeding, because positivity on Hemoccult may result from bleeding either proximal or distal to the ligament of Treitz.

• Passage of minimal amounts of bright red blood per rectum. This problem can often be clarified by an appropriate history and a careful perianal examination. Typically, the cause is an anal fissure, hemorrhoids or other distal colonic lesions. Proctoscopy combined with flexible or rigid sigmoidoscopy, in most cases on an elective basis, is usually sufficient to diagnose the problem. Learn how to save money – buy levlen to enjoy your shopping and your treatment.

• Massive LGI blood loss. Hematochezia is a term derived from the Greek haimatos, meaning ‘blood’ and chezein meaning ‘to go to stool’. Massive LGI blood loss is arbitrarily defined as bleeding below the ligament of Treitz that is severe enough to require blood transfusions of 3 to 5 U to maintain hemodynamic stability. This definition is somewhat controversial because different studies have used different criteria. Other definitions include hematocrit under 30%, any orthostatic changes in blood pressure and a requirement for any quantity of transfused blood associated with the passage of bright red blood per rectum.