diease

Blood in Stool


OVERVIEW OF Blood in Stool :

 It is also know as haematochezia and it might occurs due to internal bleeding or anyother dysfunction of the excretory system.


CAUSES :

Internal bleeding (caused due to some vascular injuries in blood vessels)

The small cut or tear lining the anus resulting  to the crack formation that occurs in the chapped lips or a paper cut. Fissures are caused by the large stool,hard which is  difficult to pass.

Colitis

Inflammation of the Colon. Inflammatory bowel disease might results in inflammation  of the colon

Angiodysplasia

A condition in which the fragile and abnormal vessel leading to the bleeding.

Peptic ulcers: An open sore in the lining of the stomach or duodenum mainly in the upper end of the small intestine. Many peptic ulcers are caused by the bacterium Helicobacterim pylori.

Long term doses of anti inflammatory drugs such as aspirin,paracetomol and naproxen resulting in the bleeding of anus.

Polyps or cancer: They are benign growth that starts to bleed and might results in and could become cancerous. Colorectal cancer is the fourth most common cause of the cancer. It often leads to bleeding that is difficult to noticeable.

Esophagus:

Varicose veins or twisting of the esophagus can lead to severe blood loss


PATHOPHYSIOLOGY :

Injury to the blood vessels in the situation such as internal bleeding might result in passage of stool with blood. It occurs when the normal anatomic and physiologic function of the excretory systems gets interrupted. Incontinence usually occurs from the multiple fcarors and it is not concerned to the single factor. The internal anal sphincter function is to cause the pressure during the resting phase and also it enhances the action of external sphincter , the anal mucosal folds, and the anal endovascular cushions. Disruption of the external sphincter results in urge related disorder or diarhhoea related disorder. Damage to the endovascular cushions results in dysfunction of the anal seal and sampling reflex. The ability of the rectum to perceive the presence of stool leads to the rectoanal contractile reflex response, an essential mechanism for maintaining continence.Pudendal  neuropathy can diminish rectal sensation and lead to excessive accumulation of stool, causing  faecal impaction, mega-rectum, and fecal overflow. The puborectalis muscle plays an integral role in maintaining the anorectal angle. Its  nerve supply is independent of the sphincter, and its precise role in maintaining continence needs to be defined. Obstetric trauma, the most common cause of anal sphincter disruption, may involve the EAS, the IAS, and the pudendal nerves singly or in combination.  These leads to the inflammatory actions and dilatation of the blood vessels surrounding the area and might cause blood in stools.


COMMON CLINICAL SIGNS AND SYMPTOMS :

Often internal bleeding can become noticed.

abdominal pain

 vomiting

weakness

 Difficulty breathing, 

diarrhoea

 Palpitations,

 fainting and 

weight loss depending on the cause, location, length, and severity of the bleeding 

irritation while passing the stools


DIAGNOSTIC :

Diagnosis:

The doctor might see and evaluate the causes of bleeding.The doctor might help to evaluate the sight of bleeding. A black, tarry stool  indicates the presence of ulcer in the upper digestive tract.Bright red colour indicated any dysfunction or abnormalities in the lower digestive tract.The main causative agent indicating the abnormalities include haemorrhoids or diverticulitis.

After certain conclusion from the physical examination the doctor might advice for the following investigation techniques:

Nasogastric lavage: A test that may tell your doctor whether bleeding is in the upper or lower digestive tract. The procedure involves removing the contents of the  stomach through a tube inserted into the stomach through the nose. If the stomach does not contain evidence of blood, the bleeding may have stopped or is more likely in the lower digestive tract.

Esophagogastroduodenoscopy (EGD). A procedure that involves inserting an  endoscope, or flexible tube with a small camera on the end, through the mouth and down the esophagus to the stomach and duodenum. The doctor can use this to look for the source of bleeding. Endoscopy can also be used to collect small tissue samples for examination under a microscope (biopsy)

Colonoscopy: it is similar to the EGD in that the scope is inserted into the rectum and colon is examined. And the abnormalities are detected.

Enteroscopy: a procedure which is similar to the EGD and colonoscopy used to examine the small intestine.In some cases this involves swallowing a capsule with a tiny camera inside that transmits images to a video monitor as it passes through the digestive tract.

Barium X-ray: A procedure that uses the barium and the barium is inserted into the digestive tract and several investigations are made. The barium must be either inserted through the rectum are swallowed.

Radionuclide scanning:

It involves injecting the radioactive material into the vein and camera is focused in it to see the images in the digestive tract to detect where the bleeding is happening.

A procedure that involves injecting a special dye into a vein that makes blood vessels visible on an X-ray or computerized tomography (CT) scan. The procedure detects bleeding as dye leaks out of blood vessels at the bleeding site.

Laparotomy. A surgical procedure in which the doctor opens and examines the abdomen. This may be necessary if other tests fail to find the cause of bleeding.

The health care providers also order lab tests when there is blood in stools. These tests may look for clotting problems, anaemia , and the presence of H. pylori infection.

Occult blood in stool:

Another "type" of blood in the stool is occult blood. Occult gastrointestinal bleeding refers to a slow loss of blood into the upper or lower gastrointestinal tract that does not change the color of the stool or result in the presence of visible bright red blood. Blood in the stool is detected only by testing the stool for blood (fecal occult blood testing) in the laboratory. Occult blood in the stool has many of the same causes as rectal bleeding, and may be associated with the same symptoms as


TREATMENT AND PROGNOSIS :

 Drugs such as Nitroglycerine or topical anesthetic creams such as lidocaine hydrochloride (Xylocaine) are used

If the bleeding is caused by the tumour or cancer then treatment involves surgery depending upon the stages.

IV infusion is indicated in complicated cases.

If the bleeding arises due to peptic ulcer then peptic ulcer drugs such as omeprazole , pantaprozole or famotidine , ranitidine can be used

If the bleeding arises due to infections then antibiotics are prescribed.

corticosteroids are used to releive the inflammation.


PROGNOSIS :

The prognosis is good when the triggering factor is taken away and proper treatment is provided.


PREVENTION :

Your treatment will depend on the cause of the redness in your diarrhea.

Intake  lots of water and other fluids. You may be able to treat diarrhea at home using over-the-counter medications, such as loperamide.

Diarrhoea which is caused by the rota virus or from E coli infection results in severe dehydration and the patient might need some hospitalization requirements for the infusion of IV fluids.

Intaking of lots of fibers rich diet or wholesome grains might leads to easy digestion and passage of tool through the anal canal and this might prevents the anal stiffness.

Intaking of lots of water and staying hydrated prevents loss of tear of anal tissue.

The best way to prevent rectal bleeding is to prevent its chief causes.

Sitz bath that is sitting in the bath dub with warm water can help to relieve symptoms.


Medicines used in the Treatment :

Nitroglycerine

lidocaine hydrochloride

loperamide

omeprazole

famotidine

corticosteroids


REFERENCE :

https://my.clevelandclinic.org

https://www.ncbi.nlm.nih.gov/pmc/articles/

https://www.sciencedirect.com/science/article/abs/pii/

https://www.hopkinsmedicine.org/