STUDY - Technical - New Dacian's Medicine
Hematochezia
(Classical / Allopathic Medicine)
Hematochezia, or
the passage of bloody stools, usually indicates - and may be
the first sign of - GI bleeding below the ligament of Treitz.
This sign is usually preceded by hematemesis and may also
accompany rapid hemorrhage of 1 L or more from the upper GI
tract.
Hematochezia
ranges from formed, blood-streaked stools to liquid, bloody
stools that may be bright red, dark mahogany, or maroon in
color (melena). This sign usually develops abruptly and is
heralded by abdominal pain.
Although
hematochezia is commonly associated with GI disorders, it may
also result from a coagulation disorder, exposure to toxins,
or a diagnostic test. Always a significant sign, hematochezia
may precipitate life-threatening hypovolemia.
ALERT:
If the patient has severe hematochezia:
- quickly check his vital signs
- look for indications of shock, such as hypotension and tachycardia
- place him in a supine position, and elevate his feet 20 to 30 degrees
- prepare for endoscopy, if necessary.
If the hematochezia isn't immediately life-threatening, perform a focused assessment.
If the patient has severe hematochezia:
- quickly check his vital signs
- look for indications of shock, such as hypotension and tachycardia
- place him in a supine position, and elevate his feet 20 to 30 degrees
- prepare for endoscopy, if necessary.
If the hematochezia isn't immediately life-threatening, perform a focused assessment.
HISTORY:
Ask the patient to fully describe the amount, color, and consistency of his bloody stools. (If possible, also inspect and characterize the stools yourself.)
Ask the patient how long the stools have been bloody. Do they always look the same or does the amount of blood vary?
Ask the patient about associated signs and symptoms, such as abdominal pain, dizziness, or signs of bleeding elsewhere in the body, such as bruising or bleeding gums.
Review the patient's medical history, noting especially GI and coagulation disorders.
Ask the patient about the use of GI irritants, such as alcohol, aspirin, and other nonsteroidal anti-inflammatory drugs.
Ask the patient to fully describe the amount, color, and consistency of his bloody stools. (If possible, also inspect and characterize the stools yourself.)
Ask the patient how long the stools have been bloody. Do they always look the same or does the amount of blood vary?
Ask the patient about associated signs and symptoms, such as abdominal pain, dizziness, or signs of bleeding elsewhere in the body, such as bruising or bleeding gums.
Review the patient's medical history, noting especially GI and coagulation disorders.
Ask the patient about the use of GI irritants, such as alcohol, aspirin, and other nonsteroidal anti-inflammatory drugs.
PHYSICAL
ASSESSMENT:
Take the patient's vital signs. Take his blood pressure and pulse while he's in a supine, sitting, or standing position.
Examine the skin for petechiae and spider angiomas.
Palpate the abdomen for tenderness, pain, or masses. Also, note lymphadenopathy.
Perform a digital rectal examination, and obtain a stool sample.
Take the patient's vital signs. Take his blood pressure and pulse while he's in a supine, sitting, or standing position.
Examine the skin for petechiae and spider angiomas.
Palpate the abdomen for tenderness, pain, or masses. Also, note lymphadenopathy.
Perform a digital rectal examination, and obtain a stool sample.
SPECIAL
CONSIDERATIONS:
Monitor the patient's vital signs, and watch for signs of shock. Monitor his intake and output.
Monitor the patient's vital signs, and watch for signs of shock. Monitor his intake and output.
PEDIATRIC
POINTERS:
Hematochezia is less common in children than in adults. It may result from a structural disorder, such as intussusception and Meckel's diverticulum, or from an inflammatory disorder, such as peptic ulcer disease and ulcerative colitis.
In children, ulcerative colitis typically produces chronic, rather than acute, signs and symptoms and may also cause slow growth and maturation related to malnutrition.
Suspect sexual abuse in all cases of rectal bleeding in children.
Hematochezia is less common in children than in adults. It may result from a structural disorder, such as intussusception and Meckel's diverticulum, or from an inflammatory disorder, such as peptic ulcer disease and ulcerative colitis.
In children, ulcerative colitis typically produces chronic, rather than acute, signs and symptoms and may also cause slow growth and maturation related to malnutrition.
Suspect sexual abuse in all cases of rectal bleeding in children.
AGING ISSUES:
Because older people have an increased risk of colon cancer, hematochezia should be evaluated with colonoscopy after perirectal lesions have been ruled out as the cause of bleeding.
Because older people have an increased risk of colon cancer, hematochezia should be evaluated with colonoscopy after perirectal lesions have been ruled out as the cause of bleeding.
PATIENT
COUNSELING:
Instruct the patient on what to expect from diagnostic testing, which may include endoscopy and GI X-ray. Teach the patient how to test his stools for occult blood.
Instruct the patient on what to expect from diagnostic testing, which may include endoscopy and GI X-ray. Teach the patient how to test his stools for occult blood.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)