What are the AAFP guidelines for recommendations for the initial evaluation and management of lower gastrointestinal (GI) bleeding (LGIB)?

Updated: Jul 26, 2019
  • Author: Burt Cagir, MD, FACS; Chief Editor: BS Anand, MD  more...
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The 2016 American Academy of Family Physicians (AAFP) guidelines recommend the following for the initial evaluation, risk stratifcation, and hemodynamic resuscitation [5] :

  • Obtain a focused history, physical examination, and laboratory studies at time of patient presentation (to determine bleeding severity and potential causes and site), while concurrently performing hemodynamic resuscitation.
  • In the presence of hematochezia and hemodynamic instability, which may indicate an upper gastrointestinal bleeding (UGIB) site, perform an upper endoscopy; if there is a moderate suspicion of UGIB, use nasogastric aspirate/lavage to help determine a potential upper GI source.
  • Perform risk assessment and stratification.
  • Administer intravenous (IV) fluid resuscitation in patients with hemodynamic instability and/or suspicion of active bleeding.
  • Transfuse packed red blood cells (PRBCs) to maintain the hemoglobin level above 7 g/dL.

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