|Blood in stool|
|The transition from the upper to lower GI tract is considered to occur at the duodenal-jejunal junction, therefore small intestine is part of both the upper and lower GI tract. Other organs participate in digestion including the liver, gallbladder, and pancreas. Blood entering the upper GI tract travels further, therefore has more exposure to the GI system and can be partially digested into melena before leaving the system. Hematochezia generally occurs lower in the GI tract, and is much closer to its exit, although fast bleeds can occur in the upper system as well.
Bleeding of the lower GI tract will typically appear as hematochezia and can vary in degree of seriousness. Slow bleeding from the ascending portion of the colon can result in partial digestion of the blood and the appearance of melena in the stool.
Blood in stool looks different depending on how early on it enters the digestive nerve pathway —and thus how a lot digestive carry through it has been exposed to—and how much there is. The term can refer either to melena, with a black appearance, typically originating from upper gastrointestinal bleed ; or to hematochezia, with a loss color, typically originating from lower gastrointestinal shed blood. [ 6 ] evaluation of the lineage found in stool depends on its characteristics, in terms of color, measure and other features, which can point to its reference, however, more serious conditions can present with a mix movie, or with the human body of bleeding that is found in another segment of the tract. [ 6 ] [ 4 ] The term “ blood in stool ” is normally only used to describe visible lineage, and not faecal occult rake, which is found only after physical examen and chemical testing ground test. In infants, the Apt test can be used to distinguish fetal hemoglobin from maternal blood based on the differences in composition of fetal hemoglobin as compared to the hemoglobin found in adults. [ 7 ] [ 8 ]
differential diagnoses [edit ]
rake in the stool can come from many sources. The causes range from not harmful to very good conditions. A common way to divide causes of bleeding is based on the source of shed blood. The GI tract can be divided into amphetamine and lower, with some causes of bleeding affecting the entire tract ( upper berth and lower ). [ 9 ] [ 10 ] Blood in the fecal matter much appears different depending on its source. These differences can help when diagnosing these conditions. The rate of bleed can besides make rake in the stool attend different from distinctive cases. [ 4 ] [ 5 ]
Reading: Blood in stool – Wikipedia
Upper GI nerve pathway [edit ]
The upper GI tract is defined as the organs involved in digestion above the ligament of Treitz and comprises the esophagus, digest, and duodenum. [ 9 ] Upper gastrointestinal bleeding is typically characterized by melena ( black stool ). Bright crimson blood may be seen with active, rapid bleeding. [ 11 ]
Pathophysiology [edit ]
The growth of blood in a person ‘s fecal matter results from a kind of conditions, which can be divided into major categories of disease. These broad categories include cancerous processes or abnormal structure of intestine rampart, inflammatory disease, colitis caused by infection or medications and vascular compromise. [ 5 ]
cancer [edit ]
Gut wall changes [edit ]
motility [edit ]
The gut wall is important for the movement of waste products through the GI tract. repetitive attempts to have a intestine movement can lead to tearing around the passing of the rectum ( anal fissure )
structural [edit ]
This number of diagnoses include diseases in which the wall of the intestine is compromised by disease. [ 5 ]
Inflammatory intestine [edit ]
Diseases causing ignition in the GI tract can lead to blood in the stool. [ 29 ] Inflammation can occur anywhere along the GI tract in Crohn ‘s disease, [ 30 ] or in the colon if a person has ulcerative colitis. [ 31 ]
colitis [edit ]
infectious colitis [edit ]
Drug-induced colitis [edit ]
vascular compromise [edit ]
- Angiodysplasia of the GI tract
- Arteriovenous malformation
- Anal fissure
- Esophageal varices
- Internal hemorrhoids are covered by a layer of mucosa and epithelium, making them more likely to bleed, but typically do not cause pain.
- External hemorrhoids are less likely to bleed, they are covered by a different type of epithelium (squamous) but can cause significant pain as a result of thrombosis of the blood vessels within them.
- Polypectomy during a colonoscopy can lead to a small amount of bleeding seen in the stool after the procedure
other causes [edit ]
- Blood in the diet, for example, the traditional diet of the Masai includes much blood drawn from cattle.
diagnosis [edit ]
The tests that are considered to evaluate of the passage of blood in the stool are based on the characteristics of shed blood ( color, measure ) and whether or not the person passing blood has a low blood pressure with exalted heart rate, as opposed to convention vital signs. [ 4 ] The pursue tests are combined to determine the causes of the reservoir of bleed .
Melena is defined as black, tarry stools, much black in color due to partial derivative digestion of the RBCs. [ 6 ]
Read more: Gastritis – Symptoms and causes
Hematochezia is defined as bright crimson rake seen in the toilet either inside of, or surrounding the stool. [ 6 ] Hematochezia is typically presumed to come from the lower part of the GI tract, and the initial steps of diagnosis include a DRE with FOBT, which if positive, will lead to a colonoscopy. [ 6 ] [ 47 ] [ 48 ] [ 4 ] If the person has a big amount of rake in their toilet, an EGD test may be necessity. [ 6 ] [ 4 ] [ 47 ] [ 48 ] If no source of active bleed is found on these examinations, a encapsulate endoscopy may be performed, in order to more close examine the little intestine, which can not be seen with the other types of studies. [ 48 ] With melena, a DRE with FOBT is much besides performed, however the suspicion for a source from the upper berth GI tract is higher, leading first to the habit of EGD with the other tests being required if no source is identified. [ 47 ] [ 48 ] The anoscopy is another type of examination, which can be used along with a colonoscopy, which exams the rectum and distal parcel of the descend colon. [ 6 ] [ 4 ]
|Color||Medical term||Frequency||Quantity||Examples of types of bleeding considered|
|Bright red||Hematochezia||Occasional occurrence of blood||Small||Hemorrhoids, inflammatory conditions, polyps|
|Bright red||Hematochezia||Increased stooling, blood with every stool||Large||Rapid bleeding, e.g. ulcer, varices|
|Dark red/black||Melena||Blood with every stool||Difficult to measure, mixed in with stool||Slow bleeding, cancer, ulcer, (peptobismol and iron use can be mimics)|
other features [edit ]
Mucus may besides be found in stool. [ 4 ] A texture described as tarry toilet is broadly associated with dark black specks in toilet [ 49 ] or bootleg stool seen in partially digested lineage. [ 6 ] This is broadly associated with melena .
affected role age [edit ]
A person ‘s age is an important consideration when assessing the campaign of the bleed. [ 4 ]
|Age||Group||Types of bleeding considered|
|<20 years||Pediatric||Inherited/autoimmune condition or structural|
|20–60 years||Middle aged||Inherited/autoimmune condition, vascular malformation|
|>60 years||Elderly||Vascular malformation, liver disease, cancer|
treatment [edit ]
treatment of bloody toilet depends largely on the campaign of the bleed. Bleeding is normally associated with symptoms of fatigue, dizziness, headaches, or even shortness of breath, and these associated symptoms besides require treatment. [ 50 ] [ 51 ] These symptoms are the solution of blood loss, and occur due to a lack of bolshevik lineage cells ( RBCs ) circulate in the vascular system, resulting in less oxygen reaching the tissues and organs. [ 52 ] [ 51 ] Blood in stool can be associated with dangerous complications as a result of rake volume personnel casualty ( bleeding ) or a slow leak of the lineage leading to low levels of hemoglobin in the circle blood ( anemia ). [ 52 ]
anemia [edit ]
Anemia is a common complicatedness of blood in the stool, specially when there is a large measure of blood or shed blood occurs over a long period of fourth dimension. [ 52 ] Anemia is besides normally associated with an cast-iron lack, due to the importance of cast-iron in the geological formation of crimson rake cells ( RBCs ). [ 51 ] When anemia is diagnosed as a solution of lineage in the stool, vitamins that are crucial for RBC geological formation ( vitamin bc, vitamin B12, and vitamin C ) are frequently prescribed in order to ensure that all the materials are available for those cells that are made. [ 51 ]
specific treatment [edit ]
diagnostic measures can be used as interventions to help stop shed blood in some cases. Bleeding that occurs due to a tumor ( cancer growth ) can be treated using colonoscopy and snip, surgical intervention, or other measures, depending on the class and phase of cancer. [ 53 ] similarly, gastric cancer is treated depending on the staging, although typically requires surgical and aesculapian therapy. [ 54 ] The discussion for motion issues, namely stultification, is typically to improve the campaign of godforsaken through the GI tract. This is done by using fecal matter softeners ( which exploit by pulling urine into the stool while in the colon ), addition of fiber to the diet, and use of osmotic laxatives ( which help fluid movement through the colon, improving overall motility ). Improving a persons gut motility can reduce the sift during apostasy and decrease the risk of developing of anal fissures. [ 55 ] Anal fissures are associated with pain and blood on the gutter paper, and require time for healing. [ 56 ] Treatment includes topical nitrates or calcium groove blockers and surgical interventions for chronic or complex cases. [ 56 ] Similar to anal fissures, inner hemorrhoids can cause lineage on the tissue when wipe, and be felt at the open of the anus. treatment options for hemorrhoids can be dependent on whether an underlie induce exists. An anorectal varices relate hemorrhoids caused by cirrhosis, however diagnostic treatment often involves removal. [ 45 ] colitis can be divided into infectious and drug induced, as can the treatment for these conditions. With infectious colitis, treatment is pathogen dependent, and generally requires the use of antibiotics. With drug-induced colitis, treatment typically involves removal of the offending agent, as is the encase in NSAID induced PUD, [ 24 ] however, removing radiation from a cancer patient is not constantly virtual within a treatment regimen, therefore checkup treatment is the primary mood of discussion. [ 57 ] structural compromise leading to blood in stool is caused by a kind of conditions, and therefore requires different treatment for each condition. peptic ulcer disease entirely can be divided into multiple causes, but is broadly initially controlled chiefly with a proton pump inhibitor, with the addition of an H2 blocker, or in serious cases, requiring surgical intervention. [ 11 ] Diverticulitis and diverticulosis require antibiotic discussion, and may require surgical interposition. [ 26 ]
Inflammatory intestine disease is besides divided into discriminate conditions, namely ulcerative colitis and Crohn ‘s disease, which have different aesculapian treatment regimens, and may require surgical intervention in more unplayful conditions. [ 30 ]
See besides [edit ]
References [edit ]