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DD of Hematochezia - Coggle Diagram
DD of Hematochezia
Cause: Bleeding from diverticula in the colon, usually the sigmoid or descending colon.
Features: Painless, sudden, and often massive rectal bleeding. No associated pain unless complicated by diverticulitis.
Tests: Colonoscopy, angiography for ongoing bleeding.
Cause: Dilated veins in the rectum or anus due to straining, pregnancy, or chronic constipation.
Features: Bright red blood on toilet paper or stool surface; often painless unless thrombosed. Associated with itching or discomfort.
Tests: Visual inspection, anoscopy, or flexible sigmoidoscopy.
Cause: Tear in the anal mucosa, often due to hard stools or trauma.
Features: Bright red blood during or after defecation, associated with severe anal pain and spasm.
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Features: Chronic blood loss, change in bowel habits, weight loss, anemia, or abdominal pain.
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Cause: Reduced blood flow to the colon, often in elderly patients with vascular disease.
Features: Sudden-onset crampy abdominal pain, followed by hematochezia. Often involves the watershed areas (splenic flexure, sigmoid colon).
Tests: CT abdomen with contrast, colonoscopy showing segmental erythema and ulcers.
Cause: Pathogens like Shigella, E. coli (EHEC), Campylobacter, Salmonella, or C. difficile.
Features: Bloody diarrhea, fever, abdominal cramps. Travel or outbreak history is common.
Tests: Stool culture, toxin assay for C. difficile.
Cause: Degenerative vascular malformations in the colon, usually the cecum or ascending colon.
Features: Intermittent painless hematochezia, often in elderly patients.
Tests: Colonoscopy, angiography for active bleeding.
Cause: Radiation therapy for pelvic cancers, causing mucosal friability.
Features: Chronic rectal bleeding, diarrhea, and pain post-radiation therapy.
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Features: Painless hematochezia, more common in children or young adults.
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- Post-Polypectomy Bleeding
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- Upper GI Bleeding
with Rapid Transit
Cause: Brisk upper GI bleeding presenting as hematochezia (e.g., peptic ulcers, varices).
Features: Hemodynamic instability, coffee-ground emesis, or melena preceding hematochezia.
Tests: Upper endoscopy, nasogastric tube aspiration.
Cause: Bleeding tendency due to anticoagulants, platelet disorders, or liver disease.
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Tests: Coagulation profile, platelet count, liver function tests.
Cause: Conditions like small bowel tumors, Crohn’s disease, or angiodysplasia.
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Tests: Capsule endoscopy, CT enterography, or balloon-assisted enteroscopy.
Diagnosis
History:
Stool appearance, associated symptoms (pain, diarrhea, weight loss).
Medications (NSAIDs, anticoagulants), prior GI history.
Physical Exam:
Signs of anemia (pallor, tachycardia), perianal inspection, and abdominal tenderness.
Investigations:
Labs: CBC, coagulation profile, renal and liver function tests.
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Management:
Stabilization with IV fluids, transfusions if necessary.
Endoscopic treatment (e.g., clipping, cautery) for active bleeding.
Address the underlying cause (e.g., antibiotics for infectious colitis, surgery for cancer).
- Inflammatory Bowel Disease (IBD)
a. Ulcerative Colitis
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Features: Bloody diarrhea, urgency, tenesmus, abdominal pain.
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b. Crohn’s Disease
Cause: Transmural inflammation, often involving the terminal ileum and colon.
Features: Bloody stools (if colonic involvement), abdominal pain, weight loss, perianal disease.
Tests: Colonoscopy showing skip lesions and deep ulcers; imaging or capsule endoscopy may be required.
Hematochezia, the passage of fresh blood or maroon-colored stools per rectum, is typically due to lower gastrointestinal (GI) bleeding but can also result from brisk upper GI bleeding. Here is a detailed differential diagnosis: