Patients with massive lower GI bleeding need to be approached similar to those with UGI hemorrhage. Institute IV fluid resuscitation immediately while initially assessing patient. Document patient's vital signs and hemodynamic stability. Draw blood for type and cross, CBC, electrolytes, liver functions, and coagulation profile. Document duration and amount of bleeding, presence of melena, or prior history of bleeding.
Abdominal exam is usually unremarkable.
Digital anal exam reveals gross evidence of rectal bleeding. Anoscopy and proctoscopy should be performed to eliminate an anorectal source of bleeding. If the NG aspirate does not contain bile an upper source cannot be excluded, but is less likely. All patients with an acute major GI bleed must be transferred to an MTF as soon as possible. The University of Iowa.