Rationale

Lower gastrointestinal bleeding is defined as blood originating distal to the ligament of Treitz. It can present as frank bleeding (hematochezia) or as occult blood loss. Although commonly seen in benign conditions, it may be the first presentation of malignancy.

Causal Conditions

(list not exhaustive)

1. Colorectal cancer or polyps

2. Diverticulosis

3. Angiodysplasia

4. Anorectal disease

5. Enterocolitis

6. Brisk bleeding from the upper gastrointestinal tract

7. Rectal trauma

Key Objectives

Particular attention should be given to the hemodynamic status of the patient and the need for immediate specialized care. The candidate will also identify patients who are at high risk for colorectal cancer for a screening colonoscopy.

Enabling Objectives

Given a patient with lower gastrointestinal tract bleeding, the candidate will

1. list and interpret critical clinical findings, including those based on

   1. a history and a physical examination, including a rectal examination as part of the initial assessment, and

   2. the patient’s hemodynamic status;

2. list and interpret critical clinical investigations, including a

   1. sigmoidoscopy, and

   2. colonoscopy and additional investigations as appropriate;

3. construct an effective initial management plan, including determining whether the patient needs immediate resuscitation and specialized care.