Hematochezia

Li Shiying
Department of Infectious Diseases,
the Second Affiliated Hospital, Chongqing Medical University
Aim and Requirements

1. Grasp the etiology of hematochezia.

2. Grasp the clinical manifestation of hematochezia.

3. Familiar the diagnostic methods of hematochezia.

 Definition
Hematochezia, is the excreted of blood from rectum
occurs after the hemorrhage of digestive tract.
Definition

• May be bright red or maroon or

melena (conversion of blood stool by
gut flora) depending on the amount
of bleeding.

• When the amount of bleeding is 5-

10ml, Fecal Occult Blood Testing (+)
Etiology

Lower GI diseases Upper GI diseases Systemic diseases

1. Intestinal diseases 1. Esophageal causes 1. Hematologic disease

2. Colon diseases 2. Gastric / duodenal 2. Infection

causes

3. Rectal diseases 3. Hepatobiliary causes 3. Connective tissue

disease

4. Intestinal vascular 4. Pancreatic causes 4. Others

malformation
Etiology
Lower GI diseases
1. Intestinal diseases
• Intestinal tuberculosis
• Jejunotyphoid fever
• Acute hemorrhagic necrotic enteritis
• Ancylostomiasis
• Crohn’s disease
• Neoplasms
• Hemangioma
• Diverticulitis
• Intestinal invagination
Etiology
Lower GI diseases
2. Colon diseases

• Acute bacillary dysentery

• Amebic dysentery

• Schistosomiasis
• Ulcerative colitis CD UC

• Colon cancer

• Colon polyps
• Ischemic colotis
Etiology
Lower GI diseases

3. Rectal diseases
• Injury

• Proctitis

• Rectal polypus
• Rectal cancer

• Hemorrhoids

• Anal fissure
• Anal fistula
Etiology

Lower GI diseases
4. Intestinal vascular malformation

• Congenital vascular malformation

• Vascular degeneration

• Hereditery telangiectasia
Etiology
Upper GI diseases
Caused by the diseases of UGI organs, such as esophageal, stomach,
duodenal, liver, gallbladder, pancreas.

1. Melena
The blood from UGI is usually chemically modified by action of acid and
enzymes.

2. Hematochezia from UGI

Is an ominous sigh, which suggests a very brisk bleed which is life
threatening (>1000ml).
Etiology
Systemic diseases
1. Hematologic disease: thrombocytopenic purpura, anaphylactoid
purpura, leukemia, haemophilia, Hodgkin’s disease, hereditary
telangiectasia, DIC and other coagulation disorders.

2. Infection: Epidemic hemorrhagic fever, leptospirosis, dengue fever,

septicemia

3. Connective tissue disease: SLE, dermatomyositis, polyarteritis

nodosa

4. Others: Uremia, vitamin C and vitamin K deficiency

Clinical Manifestation

Most of the hematochezia is the hemorrhage of lower GI

• acute massive hemorrhage

• chronic bleeding at small quantity

• intermittent bleeding
Clinical Manifestation

The color of the blood stool is related to

• the site of bleeding

• the volume of bleeding

• the length of time the blood has remained in the intestinal

cavity
Clinical Manifestation
1. Fresh bloody stool: bright red or maroon stool
• pure blood
• blood intermixed with formed stool
• bloody diarrhea

2. Melena (tarry stools): the production of black, shiny,

sticky, foul smelling.
Distinguished with exogenous stool darkeners
caused by iron or bismuth

3. Occult: Fecal Occult Blood Testing (+)

Accompanying Signs

• Abdominal pain
Recurrent, periodic, chronic abdominal pain → peptic ulceration

+jaundice+ biliary colic→ hepatic-biliary bleeding

• Tenesmus
Recal and anal disease, e.g. dysentery, proctitis, rectal cancer

• Fever
Infective disease and maglignant tumor, e.g. epidemic hemorrhagic fever,
septicemia, leukemia, lymphoma.
Accompanying Signs
• Mucocutaneous hemorrhage

Infective disease and hematologic disease, e.g. epidemic hemorrhagic fever,

leukemia, thrombocytopenic purpura, haemophilia.

• Skin changes

Skin spider nevus, liver palms → cirrhosis

• Abdominal mass
Lymphoma, colon cancer, intestinal tuberculosis, intestinal invagination, Crohn’s
disease.
Accessory Examination

• Blood routine examination

• Routine stool analysis + occult blood test

• Electronic colonoscope and gastroscope

• Ultrosound

• CT (Computed tomography)
History Taking
• Precipitating factor of hematochezia, e.g. diet, drugs, alcohol

• Color of stool and volume of bleeding

• Accompanying signs

• General conditions

• Past history: abdominal pain, diarrhea, anal fissure, drug history

and operation history.
Summary

• Recognition of Hematochezia

• Where is the source of bleeding?

• What is the causes of bleeding?

• Diagnosis
Case analysis

A 62 years old male patient has a history of gradual weight

loss, intermittent blood in the stools, altered bowel habits.

Q:
1. What are the possible reasons for the hematochezia?
2. What examination should be performed?
THANK YOU!