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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.


  • 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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