Sandbox spinalcord

# Overview
Lower gastrointestinal bleeding, commonly abbreviated LGIB, refers to any form of bleeding in the lower gastrointestinal tract.

# Causes
- Coagulopathy - specifically a bleeding diathesis
- Colitis
ischaemic colitis
ulcerative colitis
infectious colitis
E. coli O157:H7
Shigella
C. difficile
Campylobacter jejuni
- ischaemic colitis
- ulcerative colitis
- infectious colitis
E. coli O157:H7
Shigella
C. difficile
Campylobacter jejuni
- E. coli O157:H7
- Shigella
- C. difficile
- Campylobacter jejuni
- Hemorrhoids
- Angiodysplasia
- Neoplasm - cancer
- Diverticular disease - diverticulosis, diverticulitis

# Diagnosis
The following suggest an LGIB:
- Melena and a negative oesophagogastroduodenoscopy
- Hematochezia
- Fecal occult blood
The following may suggest an LGIB:
- Anemia

# Related Chapter
- Fecal occult blood
- Blood in stool
- Rectal bleeding
- Upper gastrointestinal bleeding

# Management

## Hepatic adenoma
Management of hepatic adenoma depends upon:
- Symptoms
- Size
- Number
- Location
- Certainty of the diagnosis

### Asymptomatic woman on OCPs with a small adenoma
The European Association for Study of the Liver recommends
- Discontinuation of contraceptive medication
- Close observation of the lesion with repeated imaging and alpha fetoprotein.
Contrast-enhanced magnetic resonance imaging at a six month interval to determine if there is regression of a large adenoma to less than 5 cm.
- Contrast-enhanced magnetic resonance imaging at a six month interval to determine if there is regression of a large adenoma to less than 5 cm.
- Patients with hepatic adenomas that do not resolve or that enlarge after six months of observation should undergo treatment.

### Symptomatic patients and those with large adenomas
- Surgical resection is recommended for all symptomatic patients with hepatic adenoma and those with large lesions (>5 cm).
- Surgical options include :
Enucleation
Resection
Liver transplantation
- Enucleation
- Resection
- Liver transplantation
- Nonsurgical interventions include
Transarterial embolization
Radiofrequency ablation
- Transarterial embolization
- Radiofrequency ablation

## Hepatic Hemangioma
- Asymptomatic patients
Patients with lesions <1.5 cm, are reassured and observed.
Follow-up imaging in patients with hemangiomas 5 cm in size is usually not recommended.
Patients with rapid growth of a hemangioma  or with lesions >5 cm it is recommended to repeat imaging in 6 to 12 months.
It is recommended not perform additional imaging if there is no change in the size of the lesion.
- Patients with lesions <1.5 cm, are reassured and observed.
- Follow-up imaging in patients with hemangiomas 5 cm in size is usually not recommended.
- Patients with rapid growth of a hemangioma  or with lesions >5 cm it is recommended to repeat imaging in 6 to 12 months.
- It is recommended not perform additional imaging if there is no change in the size of the lesion.
- Symptomatic patients
Patients who have pain or symptoms suggestive of extrinsic compression of adjacent structures should be considered for surgical options.
Surgical options include 
Liver resection
Enucleation
Hepatic artery ligation
Liver transplantation
Non-surgical techniques include
Hepatic artery embolization
Radiotherapy
Interferon alfa-2a
- Patients who have pain or symptoms suggestive of extrinsic compression of adjacent structures should be considered for surgical options.
- Surgical options include 
Liver resection
Enucleation
Hepatic artery ligation
Liver transplantation
- Liver resection
- Enucleation
- Hepatic artery ligation
- Liver transplantation
- Non-surgical techniques include
Hepatic artery embolization
Radiotherapy
Interferon alfa-2a
- Hepatic artery embolization
- Radiotherapy
- Interferon alfa-2a

## Focal nodular hyperplasia
- Due to their benign nature of focal nodular hyperplasia, there is
- Follow-up studies at three and six months will often be sufficient to confirm the stability of the lesion and its benign nature, after which no long-term follow-up is required routinely.
- Surgery should be reserved for symptomatic FNH lesion.
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