What are the signs and symptoms of colitis-related lower gastrointestinal (GI) bleeding (LGIB)?

Updated: Jul 26, 2019
  • Author: Burt Cagir, MD, FACS; Chief Editor: BS Anand, MD  more...
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Ischemic colitis may or may not present with abdominal pain and associated bloody diarrhea. The bloody diarrhea is self-limited but can recur if the underlying cause is not corrected. Although the clinical presentation is indistinguishable at times from that of infectious colitis, idiopathic colitis, and radiation-induced colitis, patients with ischemic colitis are usually older and have cardiovascular comorbidities. Ischemic colitis may be fulminant, presenting with acute abdominal pain, rectal bleeding, and hypotension, or this condition may be insidious, presenting with pain and rectal bleeding over several weeks.

In infectious colitis, the clinical examination findings vary depending on the volume status, amount of blood loss, extent of abdominal pain, and accompanying peritoneal signs. The clinical presentation of fever, diarrhea, dehydration, and abdominal pain can be caused by any of a number of bacterial, viral, or parasitic pathogens. The specific etiology can only be determined by isolating the organism from the stool, blood, or other tissue fluid. Patients may be quite ill and may experience intravascular volume depletion, abdominal pain, and generalized malaise, but blood loss is usually mild and a minor factor in symptomatology.

The clinical presentation of ulcerative colitis depends on whether the disease is mild, moderate, or severe. Although bleeding is minimal to none in people with mild disease, those with moderate to severe ulcerative colitis present with bloody diarrhea with pus, abdominal cramps, and dehydration. Symptoms of weight loss and fever occur in those with severe disease. Patients with Crohn disease usually present with fever, nonbloody diarrhea, and abdominal pain. However, patients with Crohn colitis can present with bloody diarrhea.

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