What should be included in the physical exam for lower gastrointestinal (GI) bleeding (LGIB)?

Updated: Jul 26, 2019
  • Author: Burt Cagir, MD, FACS; Chief Editor: BS Anand, MD  more...
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Answer

The physical examination should be thorough and include assessment of the skin, oropharynx, nasopharynx, abdomen, perineum, and anorectum to evaluate for sources of bleeding.

Because brisk upper gastrointestinal bleeding (UGIB) can present as lower GI bleeding (LGIB), placement of a nasogastric (NG) tube may be necessary, with the aspirate or lavage examined for the presence of blood and/or bile. These aspirates usually correlate well with upper gastric hemorrhage proximal to the Treitz ligamentum; therefore, insert an NG tube to confirm the presence or absence of blood in the stomach.

If necessary, perform gastric lavage with warm isotonic fluids to obtain bilious discharge; an aspirate that is positive for bile is comprehensive in that it includes fluid even beyond the pylorus. In such a scenario, if no blood is present, a UGIB source only makes sense if the bleeding has stopped. If this possibility exists, an esophagogastroduodenoscopy (EGD) should be performed to obtain a more specific evaluation of the upper GI tract. Place a Foley catheter to monitor urine output. Careful digital rectal examination, anoscopy, and rigid proctosigmoidoscopy should exclude an anorectal source of bleeding.


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