Patient handout

Lower GI Bleeding

PRODUCTION

1. Your condition

This handout is for lower gi bleeding. Your care team identified this based on: hematochezia (bright red blood per rectum) (acg 2024).

Other reasons your team may use this plan: melena (consider brisk upper source — ~15% of apparent lgib) (acg 2024); syncope / presyncope with rectal bleeding (acg 2024); acute drop in hemoglobin (acg 2024).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
normal_saline_or_LR	500-1000 mL IV bolus titrated	IV	PRN	Initial volume restoration
packed_red_blood_cells	1-2 units	IV	PRN	Restrictive transfusion threshold per ACG 2023 / Villanueva 2013

Plan: LGIB acute regimen — resuscitation + reversal + colonoscopic/IR hemostasis (ACG 2023)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

SBP <90 or HR >110 with ongoing hematochezia (ACG 2024)
Hematochezia with BUN:Cr >30 OR hemodynamic disproportion (massive shock with limited rectal output) (ACG 2024)
Active LGIB on warfarin (INR >1.5), DOAC, or recent thrombolysis (ACG 2024)
Hgb drop ≥2 g/dL OR recurrent hematochezia within 72h of index colonoscopy (ACG 2024)
Rebound, guarding, free air on imaging in LGIB context (ACG 2024)(life-threatening)

5. Follow-up

Discharge if Oakland ≤8; outpatient colonoscopy within 7d if not done; GI follow-up 2-4 weeks; anticoag resumption with cardiology; iron repletion; recurrence counseling (ACG 2024)

6. Sources

Guideline: ACG 2023 LGIB Guideline (Strate & Gralnek) + ESGE 2021 LGIB + BSG 2019 LGIB (Oakland score derivation) + Villanueva 2013 restrictive transfusion (NEJM)