Acute lower gastrointestinal bleeding: A guide to initial management

Initial assessment of any patient with acute gastrointestinal bleeding includes thorough history taking and physical examination, with special attention to orthostatic changes in vital signs as a guide to severity of blood loss. The next crucial step is exclusion of massive upper gastrointestinal hemorrhage. Once that is accomplished, a lower gastrointestinal source should be sought. Diagnostic options include bleeding scans, colonoscopy, and angiography. The latter two measures confer therapeutic advantages, especially for diverticular disease and angiodysplastic lesions, which are the most common causes of acute lower gastrointestinal bleeding.