All upper
GI bleeding, with the exception of a likely Mallory-Weiss tear
in a patient < 40 years of age (see below)
Any hematochezia/lower
GI bleeding in a patient > 40 years
Hematochezia/lower
GI bleeding in a patient < 40 years of age if history is not
consistent with anorectal source, or if history is consistent
with ongoing infectious or inflammatory condition
Recurrent
hematochezia from presumed anorectal source despite medical therapy
in a patient < 40 years of age
Hemoccult-positive
stool in the context of colorectal cancer screening
Iron deficiency
anemia
If >
40 years of age
If <
40 years of age with no other cause (malnutrition, menses)
All obscure
GI bleeding
Referral
not recommended
Isolated hematemesis
if history is consistent with Mallory-Weiss tear, and anemia and
upper GI symptoms are absent
Hematochezia
if history is consistent with anorectal source, and a fissure
or bleeding hemorrhoids are seen on exam/anoscopy in a patient
< 40 years of age