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Haematochezia

Overview

  • Haematochezia refers to the symptom of right red per-rectal blood. This is often a distressing symptom that may herald a lower GI bleed or a massive upper GI bleed.

Aetiology

    • Causes of Haematochezia

    • Lower GI Bleed

    • Inflammation - inflammatory bowel disease, diverticular disease, infectious colitis, ischaemic colitis
    • Mass - carcinoma, polyp
    • Anorectal disorders - haemorrhoids, fissure in ano, fistula in ano, perianal ulcer, anal SCC
    • Arteriovenous malformation
    • Trauma
    • Massive Upper GI Bleed

    • Variceal bleed
    • Peptic ulceration

History of Presenting Complaint

    • Blood

      Whether the blood is in the stool, in the toilet bowl or on toilet paper; whether it is frank red blood or clots.
    • Blood on toilet paper onlyMore likely to be anorectal e.g. haemorrhoids, fissure
    • Blood in the stoolMore likely to represent colorectal disease
    • Blood in the toilet bowlSuggestive of high volume bleed
    • Heavy bleedingSuggestive of diverticular bleed or AV malformation
    • Minor bleedingSuggestive of haemorrhoids, polyp or cancer
    • Onset

    • Under what circumstances the bleeding began.
    • Timing

    • How long the patient has noticed the blood for.
    • Associated Symptoms

      Whether the PR blood is associated with any other symptoms.
    • Lower Abdominal PainSuggestive of colitis of any cause
    • Weight lossSuggestive of colorectal cancer
    • FeversSuggestive of infectious or inflammatory cause
    • DiarrhoeaSuggestive of inflammatory cause, e.g. infection, inflammation, ischaemia or tumour
    • Presyncope or syncopeRed flag for hypovolaemia
    • HaematemesisSuggestive of massive upper GI bleed
    • Perianal massPotential haemorrhoids, abscess or anal SCC
    • Sharp anorectal pain on passing stoolsSuggestive of anal fissure
    • Severity

    • Number of bloody stools or amount of blood passed.

Extra Credit

    • Rare Causes of Gastrointestinal Bleeding

    • Cameron lesions: linear erosions / ulcerations found at the subdiaphragmatic end of a hiatus hernia
    • Dieulafoy leisons: congenitally superficial arteries within the mucosa / submucosa that erode and bleed with minor trauma
    • Cancer of the small intestine
    • Varices - small intestine, colon, rectum, peristomal, gallbladder, bile duct, pancreasPortal hypertension
    • Haemosuccus pancreaticus: bleeding from the pancreas into the ampulla of VaterPancreatitis, malignancy, trauma, arteriovenous malformation
    • Haemobilia: bleeding from the biliary systemIatrogenic, trauma, malignancy, hepatic abscess / cyst, arteriovenous malformation
    • Aortoenteric fistula
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Associated Diseases
BETA

Gastric & Small Bowel
Inflammatory Bowel Disease
Other
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