Hematochezia

Hematochezia
Hematochezia is the passage of fresh blood through the anus, usually

in or with stools. Hematochezia is commonly associated with lower
gastrointestinal bleeding, but may also occur from a brisk upper
gastrointestinal bleed. The difference between hematochezia and
rectorrhagia is that the latter rectal bleeding is not associated with
defaecation. Instead, it is associated with expulsion of fresh bright red
blood without stools. The phrase bright red blood per rectum (BRBPR)
is associated with hematochezia and rectorrhagia.
Causes
In adults, most common causes are hemorrhoids and diverticulosis,
both of which are relatively benign; however, it can also be caused by
colorectal cancer, which is potentially fatal. In a newborn infant,
hematochezia may be the result of swallowed maternal blood at the
time of delivery, but can also be an initial symptom of necrotizing
enterocolitis, a serious condition affecting premature infants. In babies,
hematochezia in conjunction with abdominal pain is associated with
intussusception. In adolescents and young adults, inflammatory bowel
disease, particularly ulcerative colitis, is a serious cause of
hematochezia that must be considered and excluded.
Hematochezia can be due to upper gastrointestinal bleeding. However,
as the blood from such a bleed is usually chemically modified by action
of acid and enzymes, it presents more commonly as melena.
Hematochezia from an upper gastrointestinal source is an ominous
sign, as it suggests a very significant bleed which is more likely to be
life threatening.
Beeturia can cause red colored feces after eating beets because of
insufficient metabolism of a red pigment, and is a differential sign that
may be mistaken as hematochezia.
Consumption of dragon fruit or pitaya may also cause red discoloration
of the stool and sometimes the urine.This too, is a differential sign that
is sometimes mistaken for hematochezia.
Melena
In medicine, melena or melna refers to the black, "tarry" feces that
are associated with gastrointestinal hemorrhage. The black color is
caused by the hemoglobin in the blood being altered by digestive
chemicals and intestinal bacteria.
Iron supplements may cause a grayish-black stool that should be
distinguished from the black, tarlike stool that occurs from bleeding
ulcer.
Causes
The most common cause of melena is peptic ulcer disease. Any other
cause of bleeding from the upper gastrointestinal tract, or even the
ascending colon, can also cause melena. Melena may also be a sign of
drug overdose if a patient is taking anticoagulants, such as warfarin. It
is also caused by tumors, especially malignant tumors affecting the
esophagus, more commonly the stomach & less commonly the small
intestine due to their bleeding surface. However,the most prominent
and helpful sign in these cases of malignant tumors is haematemesis.
It may also accompany hemorrhagic blood diseases (e.g. purpura &
hemophilia). Other medical causes of melena include bleeding ulcers,
gastritis, esophageal varices, and Meckel's diverticulum
Causes of "false" melena include iron supplements, Pepto-Bismol,
Maalox, and lead, blood swallowed as a result of a nose bleed
(epistaxis), and blood ingested as part of the diet, as with consumption
of black pudding (blood sausage), or with the traditional African Maasai
diet, which includes much blood drained from cattle.
Melena is often a medical emergency as it arises from a significant
amount of bleeding. Urgent care is required to rule out serious causes
and prevent potentially life-threatening emergencies.
A less serious, self-limiting case of melena can occur in newborns two
to three days after delivery, due to swallowed maternal blood.
Melena vs. hematochezia
Bleeds that originate from the lower GI tract (such as the sigmoid colon
and rectum) are generally associated with the passage of bright red
blood, or hematochezia, particularly when brisk. Only blood that
originates from a high source (such as the small intestine), or bleeding
from a lower source that occurs slowly enough to allow for enzymatic
breakdown is associated with melena. For this reason, melena is often
associated with blood in the stomach or duodenum for example by a

peptic ulcer. A rough estimate is that it takes about 14 hours for blood
to be broken down within the intestinal lumen; therefore if transit time
is less than 14 hours the patient will have hematochezia, and if greater
than 14 hours the patient will exhibit melena. One often-stated rule of
thumb is that melena only occurs if the source of bleeding is above the
ligament of Treitz although, as noted below, exceptions occur with
enough frequency to render it unreliable.

Hematochezia

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Hematochezia

Hematochezia is the passage of fresh blood through the anus, usually

associated with blood in the stomach or duodenum for example by a

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