... Hemorrhoids are dilated perianal veins that become thrombosed or can rupture, producing subcutaneous or submucosal hematomas. They are usually due to chronic constipation but may be the cause of constipation also. Although they are usually considered to be a disease, it is
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Is it true or false melena? False melena may be induced by iron ingestion, bismuth ingestion, charcoal ingestion, red wine ingestion, and many other substances.
Is there a history of alcohol or drug ... DIAGNOSTIC WORKUP
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Is it severe? The presence of severe rectal bleeding would suggest ulcerative colitis, amebic dysentery, bacillary dysentery, intussusception, mesenteric thrombosis or embolism, diverticulitis, ischemic colitis, and ... DIAGNOSTIC WORKUP
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Is there bleeding? The presence of bleeding with pain suggests an anal fissure, hemorrhoids, carcinoma, rectal prolapse, and intussusception.
Is there a mass? The presence of rectal pain along with a mass would suggest internal and external ... DIAGNOSTIC WORKUP
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Hemorrhoids are not protruding “varicose veins”—they are distinct from the rectal varices of portal hypertension. Rather, hemorrhoids are downwardly displaced anal cushions, which are normal vascular tissue (sinusoids) that protect the anal canal during... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Rectal complaints are common and distressing for patients. Although most causes of rectal pain and bleeding are benign and treatable, carcinoma must be considered and ruled out in older patients (>40 years) and those with suggestive findings (e.g.,... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Lower GI tract bleeding occurs distal to the ligament of Treitz (which separates the duodenum from the jejunum) and refers to the passage of either bright red blood per rectum (hematochezia), maroon stools, or black, tarry stools (melena). Hematochezia suggests either bleeding from the... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Hematemesis refers to vomiting of clots, fresh blood, or “coffee grounds” and generally represents bleeding from the upper GI tract (i.e., proximal to the ligament of Treitz). May be associated with black, tarry stools (melena). The spectrum of upper GI bleeding varies... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Hematochezia refers to bright red blood per rectum (BRBPR). When the blood is maroon, the bleeding source is usually colonic. Massive upper GI bleed may rarely present with BRBPR because blood is a cathartic and children have a short intestinal transit time. Milk protein allergy is... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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... 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 261.) Bright-red blood may occasionally result from an upper GI lesion if
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... Practically the whole specialty of proctology is devoted to taking care of patients with rectal pain. To develop the differential diagnosis it is useful first to divide the conditions into extrinsic and intrinsic. To recall the extrinsic causes one
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... Hematemesis means vomiting or regurgitation of frank bright red blood or coffee-ground material that is positive for occult blood. It may be differentiated from hemoptysis because it usually gives an acidic reaction to nitrazine paper. It may be swallowed
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... Aside from the common external hemorrhoids (which will not be seen in many cases unless the patient is asked to bear down), anal masses may include any of the following:
Skin tag from previous ruptured or incised hemorrhoids
Sentinel
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... Bleeding from the Ear
This is not usually a serious condition. Anatomy is again applied to formulate a diagnosis. The blood may be from the external or middle ear and usually is caused by diseases of the skin or drum. Trauma is the most significant
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...Rectal bleeding
The passage of bloody stools, also known as hematochezia, usually indicates — and may be the first sign of — GI bleeding below the ligament of Treitz However, this sign — usually preceded by hematemesis —... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations
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... A common sign of upper GI bleeding, melena is the passage of black, tarry stools containing digested blood. The characteristic color results from bacterial degradation and hydrochloric acid acting on the blood as it travels through the GI tract. At least 60 ml of blood is needed to... Emergency Interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Pictures
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... A common symptom of anorectal disorders, rectal pain is discomfort that arises in the anorectal area. Although the anal canal is separated from the rest of the rectum by the internal sphincter, the patient may refer to all local pain as rectal pain. ... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers ... Geriatric pointers
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... Postmenopausal vaginal bleeding — bleeding that occurs 6 or more months after menopause — is an important indicator of gynecologic cancer. But it can also result from infection, a local pelvic disorder, estrogenic stimulation, atrophy of the endometrium, and physiologic... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Geriatric pointers
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... Upper Gastrointestinal Bleeding
Inflammation
Esophageal ulcer
Gastric ulcer*
Duodenal ulcer*
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... 1. Feldman M, Scharschmidt BF, Sleisenger MH (eds): Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 6/e. Philadelphia: WB Saunders, 1997.
2. Haubrich WS, Schaffner F, Berk JE (eds): Bockus
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... Oral or Oropharynx
Infections
Candida spp.
HSV
CMV
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... Hemorrhoids are varicosities in the superior or inferior hemorrhoidal venous plexus. Dilation and enlargement of the superior plexus produce internal hemorrhoids; dilation and enlargement of the inferior plexus produce external hemorrhoids that may protrude from the rectum... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations ... Pictures
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... The GI tract, also known as the alimentary canal, is a long, hollow, musculomembranous tube consisting of glands and accessory organs (salivary glands, liver, gallbladder, and pancreas). (See Reviewing GI anatomy and physiology, page 684, and Histology of the GI... Accurate assessment vital ... Visual assessment ... Auscultation, palpation, and percussion ... Diagnostic tests ... Intubation ... Pictures
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... Postmenopausal bleeding is defined as bleeding from the reproductive tract that occurs 1 year or more after cessation of menses. Sites of bleeding include the vulva, vagina, cervix, and endometrium. The prognosis varies with the cause.
Causes
... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... A common sign of upper GI bleeding, melena is the passage of black, tarry stools containing digested blood. Characteristic color results from bacterial degradation and hydrochloric acid acting on the blood as it travels through the GI tract. At least 60 ml of... Emergency Interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Pictures
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... A common symptom of anorectal disorders, rectal pain is discomfort that arises in the anorectal area. Although the anal canal is separated from the rest of the rectum by the internal sphincter, the patient may refer to all local pain as rectal pain.
Because the... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling
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... The passage of bloody stools, also known as hematochezia, usually indicates—and may be the first sign of—GI bleeding below the ligament of Treitz. However, this sign—usually preceded by hematemesis—may also accompany rapid... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers
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... Postmenopausal vaginal bleeding—bleeding that occurs 6 or more months after menopause—is an important indicator of gynecologic cancer. But it can also result from infection, a local pelvic disorder, estrogenic stimulation, atrophy of the... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Geriatric pointers ... Patient counseling
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... Ted Epperly
Rectal bleeding is a common problem encountered by primary care providers across the United States. Annually, approximately 3% of the general population will report seeing blood in the toilet bowl and roughly 12% to 20% will note blood on the... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment ... Pictures
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... Mark B. Stephens
Gastrointestinal (GI) bleeding is responsible for 1% to 2% of all hospital admissions in the United States (1). Bleeding can be either acute or chronic. The source can be upper or lower, overt or occult. The patient can be either... Approach ... History ... Physical examination ... Laboratory evaluation ... Diagnostic assessment ... Pictures
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... Victoria S. Kaprielian
Postmenopausal bleeding is defined as vaginal bleeding that occurs in a woman who has had no menses for a year or more. This is a common outpatient problem, estimated to account for approximately 5% of gynecologic office visits. ... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment
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... Differential Overview
❑ Hemorrhoid
❑ Rectal fissure
❑ Prostatitis
❑ Anal fistula
❑ Pruritus ani ... Diagnostic Approach ... Clinical Findings
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... Differential Overview
Upper GI
❑ Peptic ulcer disease
❑ Gastritis
❑ Mallory-Weiss tear
❑ Esophageal varices ... DIagnostic Approach ... Clinical Findings ... Pictures
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... Hemorrhoidal varices are part of the normal anatomy. Dilation and enlargement of the superior plexus of the superior hemorrhoidal veins located above the dentate line produce internal hemorrhoids. Enlargement of the plexus of the inferior hemorrhoidal veins located below... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... The passage of bloody stools, also known as hematochezia, usually indicates — and may be the first sign of — GI bleeding below the ligament of Treitz. However, this sign — usually preceded by hematemesis — may also accompany rapid hemorrhage of 1 L... Assessment ... History ... Physical examination ... Pediatric pointers ... Geriatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
... READ EXCERPTS »
... A common sign of upper GI bleeding, melena is the passage of black, tarry stools containing digested blood. Characteristic color results from bacterial degradation and hydrochloric acid acting on the blood as it travels through the GI tract. At... Assessment ... History ... Physical examination ... Pediatric pointers ... Geriatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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... The passage of bloody stools, also known as hematochezia, usually indicates — and may be the first sign of — GI bleeding below the ligament of Treitz. However, this sign — usually preceded by hematemesis — may also accompany rapid hemorrhage of 1 L or more... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... A common sign of upper GI bleeding, melena is the passage of black, tarry stools containing digested blood. Characteristic color results from bacterial degradation and hydrochloric acid acting on the blood as it travels through the GI tract. At least... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... A common symptom of anorectal disorders, rectal pain is discomfort that arises in the anorectal area. Although the anal canal is separated from the rest of the rectum by the internal sphincter, the patient may refer to all local pain as rectal pain. ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... Postmenopausal vaginal bleeding — bleeding that occurs 6 or more months after menopause — is an important indicator of gynecologic cancer, but it can also result from infection, a local pelvic disorder, estrogenic stimulation, atrophy of... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Geriatric pointers ... Patient counseling ... Pictures
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... Can occuranywhere from nose and mouth to anus. Bleeding that occurs proximal to ligamentof Treitz is considered upper tract bleeding, whereas bleeding thatoccurs distal to this ligament is considered lower tract bleeding. Manifestations include... Principal Causes of Gastrointestinal Bleeding ... Clinical Features and Diagnosis ... Diagnostic Approach ... References
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... A common sign of upper GI bleeding, melena is the passage of black, tarry stools containing digested blood. The characteristic color results from bacterial degradation and hydrochloric acid acting on the blood as it travels through the GI tract. At least 60 ml of blood in the GI tract is... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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... A common symptom of anorectal disorders, rectal pain is discomfort that arises in the anorectal area. Although the anal canal is separated from the rest of the rectum by the internal sphincter, the patient may refer to all local pain as rectal pain.
... History and physical examination ... Medical causes ... Nursing considerations ... Patient teaching
... READ EXCERPTS »
... The passage of bloody stools, also known as hematochezia, usually indicates—and may be the first sign of—GI bleeding below the ligament of Treitz. However, this sign—usually preceded by hematemesis—may also accompany rapid hemorrhage of 1 L or more from the upper... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
... READ EXCERPTS »
... Postmenopausal vaginal bleeding—bleeding that occurs 6 or more months after menopause—is an important, albeit not a definitive, indicator of gynecologic cancer. It can also result from infection, a local pelvic disorder, estrogenic stimulation, atrophy of the endometrium,... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
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...
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... Pictures
... READ EXCERPTS »
...
Practically the whole specialty of proctology is devoted to taking care
of patients with rectal pain. To develop the differential diagnosis it is
useful first to divide the conditions into extrinsic and
intrinsic. To... Pictures
... READ EXCERPTS »
...
Aside from the common external hemorrhoids (which will not be seen in
many cases unless the patient is asked to bear down), anal masses may
include any of the following:
... Pictures
... READ EXCERPTS »
...
Hematemesis means vomiting or regurgitation of frank bright red
blood or coffee-ground material that is positive for occult blood. It may be
differentiated from hemoptysis because it usually gives an acidic reaction
to nitrazine paper. It may be... Pictures
... READ EXCERPTS »
...
Bleeding from the ear. This is not usually a serious
condition. Anatomy is again applied to formulate a diagnosis. The
blood may be from the external or middle ear, and usually is caused by
diseases of the skin or drum. Trauma is the most
... READ EXCERPTS »
... Author:
Mindy Dickerman, MD
What to Do - Gather Appropriate Data
GI bleeding can be divided into upper GI hemorrhage (bleeding proximal
to the ligament of Treitz) and lower GI hemorrhage (bleeding distal to that
point). It is... Suggested Readings
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... Author:
Laura Hufford, MD
What to Do - Interpret the Data
In newborns, one of the most common causes of blood in the stool is swallowed maternal blood. This occurs either during the delivery process or
during breastfeeding if... Suggested Readings
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... Maria R. Mascarenhas, MBBSKristin N. Fiorino, MD Lower GI Bleeding - BASICS Lower GI Bleeding - description Lower GI bleeding refers to bleeding from the lower GI tract, distal to the ligament of Treitz. ... Lower GI Bleeding - DIAGNOSIS ... Lower GI Bleeding - TREATMENT ... Lower GI Bleeding - FOLLOW UP ... Lower GI Bleeding - bibliography ... Lower GI Bleeding - CODES ... Lower GI Bleeding - FAQ
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... Maria R. Mascarenhas, MBBSJudith Kelsen, MD Upper Gastrointestinal Bleeding - BASICS Upper Gastrointestinal Bleeding - description Vomiting of blood, whether bright red or dark, constitutes upper GI bleeding or hematemesis. This usually... Upper Gastrointestinal Bleeding - DIAGNOSIS ... Upper Gastrointestinal Bleeding - TREATMENT ... Upper Gastrointestinal Bleeding - FOLLOW UP ... Upper Gastrointestinal Bleeding - bibliography ... Upper Gastrointestinal Bleeding - CODES ... Upper Gastrointestinal Bleeding - FAQ
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A tiny camera called laparoscope can be used to peek inside the body and diagnose disease. Learn how this minimally invasive technique is now being...
Non-steroidal anti-inflammatory drugs, commonly known as NSAIDs, are taken to relieve common aches and pains. However, for some people, these drugs...
Diarrhea is a well-known side-effect of certain chemotherapies, and while for some patients it's a minor nuisance, for others it may become a...
Non-steroidal anti-inflammatory drugs (NSAIDs) are used by many people to relieve pain. However, since they are so commonly used, most people...