RECTAL BLEEDING
RECTAL BLEEDING: Excerpt from Differential Diagnosis in Primary Care
This discussion considers the causes of bright red or maroon stools.
(The causes of melena or black stools are the same as the causes of
hematemesis; the differential diagnosis is given on page 215.) Bright-red blood may occasionally result from an
upper GI lesion if there is associated diarrhea.
A list of the causes of rectal bleeding of fresh blood is best developed
with the use of the mnemonic VINDICATE.
V—Vascular conditions prompt the recall of
hemorrhoids, but one cannot forget mesenteric infarctions.
I—Inflammation suggests perirectal abscess, anal fissure or
ulcer, amebic colitis, or condyloma latum and acuminatum.
N—Neoplasms call to mind polyps and carcinomas of the rectum and
anus.
D—Degenerative disorders do not suggest
anything in particular.
I—Intoxication suggests pseudomembranous colitis complicating
gentamicin, clindamycin, and other antibiotic therapy. Jejunal ulcers from
potassium chloride tablets should be considered here.
C—Congenitaland acquired anomalies suggest fistula in
ano, bleeding Meckel diverticulum, and bleeding colonic diverticula, among
other congenital conditions. Intussusception would fall in this category
also.
A—Autoimmune diseases recall
granulomatous colitis and ulcerative colitis.
T—Trauma suggests the bleeding from any foreign body inserted
into the rectum, including the male organ.
E—Endocrine disorders do not suggest
anything other than the Zollinger–Ellison syndrome, which, because it
causes ulceration of the jejunum, may be associated with maroon stools.
In disorders of the upper colon and small intestines, the blood is
older and thus a maroon color is likely. In addition, the blood is mixed
with the stool and may indeed be so well mixed that it will not be
discovered without a test for occult blood. Other features are more
prominent in bacillary dysentery and salmonellosis.
Approach to the Diagnosis
Armed with a more comprehensive list of causes of rectal bleeding, the
clinician is ready to eliminate some of them as he or she asks appropriate
questions during the history and performs the examination with all the
causes in mind. The diagnosis may be pinned down by the presence or absence
of other symptoms and signs. The principal diagnostic procedures are stool
cultures, stool examination for ova and parasites, proctoscopy, barium
enema, and colonoscopy.
Other Useful Tests
-
CBC (infection)
-
Urinalysis (systemic disease)
-
Sedimentation rate (infection, granulomatous, or ulcerative
colitis)
-
Chemistry panel (liver disease)
-
Frei test (lymphogranuloma venereum)
-
Rectal biopsy (colitis, neoplasm)
-
Small-bowel series (neoplasm)
-
Angiogram (mesenteric thrombosis)
Pictures
Book Source Details
- Book Title: Differential Diagnosis in Primary Care
- Author(s): R. Douglas Collins MD, FACP
- Year of Publication: 2007
- Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.
More About Anal Cancer
More Medical Textbooks Online about Anal Cancer
Review other book chapters online related to Anal Cancer:
Medical Books Excerpts
- ANAL MASS
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
- Rectal pain
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Rectal Bleeding
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Rectal pain
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- ANAL MASS
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
» Next page: RECTAL PAIN (Differential Diagnosis in Primary Care)
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