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Acute lower intestinal bleedingPart I: Clinical presentation and diagnosis

      Synonyms for lower intestinal bleeding include lower gastrointestinal bleeding,
      • Longstreth GF
      Epidemiology and outcome of patients hospitalized with acute lower gastrointestinal hemorrhage: a population-based study.
      • Richter JM
      • Christensen MR
      • Kaplan LM
      • Nishioka NS
      Effectiveness of current technology in the diagnosis and management of lower gastrointestinal hemorrhage.
      rectal bleeding,
      • Caos A
      • Benner KG
      • Manier J
      • McCarthy DM
      • Blessing LD
      • Katon RM
      • et al.
      Colonoscopy after golytely preparation in acute rectal bleeding.
      • Levinson SL
      • Powell DW
      • Callahan WT
      • Jones JD
      • Kinard HB
      • Jackson AL
      • et al.
      A current approach to rectal bleeding.
      • Forde KA
      Colonoscopy in acute rectal bleeding.
      visible rectal bleeding,
      • Hefland M
      • Marton KI
      • Zimmer-Gembeck MJ
      • Sox HC
      History of visible rectal bleeding in a primary care population. Initial assessment and 10-year follow-up.
      colonic bleeding,
      • Colacchio TA
      • Forde KA
      • Patsos TJ
      • Nunez D
      Impact of modern diagnostic methods on the management of active rectal bleeding—ten year experience.
      • Bramley PN
      • Masson JW
      • McKnight G
      • Herd K
      • Fraser A
      • Park K
      • et al.
      The role of an open-access bleeding unit in the management of colonic hemorrhage. A 2-year prospective study.
      and bloody diarrhea.
      • Vernava AM
      • Moore BA
      • Longo WE
      • Johnson FE
      Lower gastrointestinal bleeding.
      Lower intestinal bleeding has also been referred to by the color and character of the bloody stool: bright red blood per rectum, maroon stool, blood and clots per rectum, and hematochezia.
      • Longstreth GF
      Epidemiology and outcome of patients hospitalized with acute lower gastrointestinal hemorrhage: a population-based study.
      • Richter JM
      • Christensen MR
      • Kaplan LM
      • Nishioka NS
      Effectiveness of current technology in the diagnosis and management of lower gastrointestinal hemorrhage.
      • Jensen DM
      • Machicado GA
      Diagnosis and treatment of severe hematochezia. The role of urgent colonoscopy after purge.
      These descriptions and the designation “lower” become problematic when it is appreciated that the passage of blood per rectum can originate from any level in the gastrointestinal tract. A look at consecutive patients with acute gastrointestinal bleeding from either the upper or lower tract found that at least 80% of patients will pass blood, in some form, from the rectum.
      • Kollef MH
      • O'Brien JD
      • Zuckerman GR
      • Shannon W
      BLEED: a classification tool to predict outcomes in patients with acute upper and lower gastrointestinal hemorrhage.
      In fact, one study found upper gastrointestinal bleeding (UGIB) to be the source in as many as 11% of patients given the designation hematochezia.
      • Jensen DM
      • Machicado GA
      Diagnosis and treatment of severe hematochezia. The role of urgent colonoscopy after purge.
      Thus, lower intestinal bleeding has the potential for a more diverse and complicated differential diagnosis than UGIB.
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