What Is The Main Cause Of Blood In Urine – Hematochezia refers to the passage of fresh, bright red blood in the stool and is typically indicative of bleeding originating from the lower gastrointestinal (GI) tract. The lower GI tract is anatomically defined as the region distal to the ligament of Treitz, which is the thin band of tissue that connects and supports the end of the duodenum and the beginning of the jejunum. Hematochezia is not to be confused with melena, which refers to the passage of black, tarry stools originating from the upper GI tract, which is located proximal to the ligament of Treitz.
The causes of hematochezia in adults are usually inflammatory bowel disease (IBD), including ulcerative colitis; hemorrhoids; and bleeding from a diverticulum in the colon. In addition, peptic ulcer disease and esophageal varices are causes of upper gastrointestinal bleeding that can produce hematochezia when severe.
- 1 What Is The Main Cause Of Blood In Urine
- 2 Gastrointestinal Bleeding: Causes, Symptoms & Prevention
- 3 Leukemia: Signs, Symptoms, And Complications
What Is The Main Cause Of Blood In Urine
Ulcerative colitis is a subtype of inflammatory bowel disease that involves autoimmune attack of the large intestine (ie, colon), resulting in inflammation and ulceration of the mucosal lining. Severe ulcerative colitis can result in hematochezia due to bleeding from the ulcers.
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Hemorrhoids are swollen veins in the lower right and can be painful or painful, depending on whether they are located internally or externally, respectively. They are usually caused by straining during bowel movements and are associated with obesity and pregnancy. When the walls of the blood vessels in the hemorrhoid expand too thin as a result of increased pressure in the lower rectum, typically from straining, hematochezia can occur.
Diverticulosis is a condition that occurs when small pouches (i.e. diverticulum) form and push outward through the wall of the large intestine, which can cause bleeding. Genetics or a high-fat, low-fiber diet make an individual more likely to develop diverticular pouches.
Peptic ulcer disease occurs when the protective mucosal lining of the stomach and the duodenum of the small intestine is eroded by infection with the bacteria Helicobacter pylori (H. pylori) or long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs). If the ulcer is strong, rapid bleeding can occur, and immediate treatment is necessary because of the risk of hypovolemic shock.
Esophageal varices refer to the presence of enlarged veins in the esophagus due to obstruction of flow through the portal vein, which is often caused by severe liver scarring. The backup of blood can lead to esophageal vein rupture, which presents as massive amounts of blood loss and melena (i.e. black, tarry stool) or hematochezia.
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In older individuals, arteriovenous malformation (AVM) can lead to multiple repeated, often smaller, bleeds. An AVM is a vascular lesion that can occur anywhere along the GI tract, usually in the colon and is related to advanced age; chronic kidney disease; and certain types of heart disease, such as aortic stenosis. Less common causes of colonic bleeding in adults are cancer and ischemic colitis (ie, inflammation of the colon).
The causes of hematochezia in neonates are necrotizing enterocolitis and midgut volvulus. Necrotizing enterocolitis refers to the death of the tissue in parts of the large intestine due to reduced blood flow, and midgut volvulus occurs when the intestine is twisted during embryonic development.
The signs and symptoms of hematochezia usually include light red blood in the stool seen in the toilet or on the toilet paper when wiping as well as the feeling of pain or pressure in the rectum. In many cases, an individual with hematochezia may not be aware of their hematochezia and may not report any symptoms. In other cases, individuals may experience abdominal pain, vomiting, diarrhea, weakness, difficulty breathing, palpitations, and even syncope (that is, fainting) depending on the cause and severity of bleeding. Hematochezia that has been present for a long time can lead to excessive blood loss, resulting in anemia, which can lead to palpitations, shortness of breath and syncope. Excessive and rapid blood loss can also cause hypovolemia and shock. Furthermore, bleeding associated with underlying malignancy (ie, colorectal cancer) may present with unintentional weight loss.
Hematochezia can be diagnosed on patient history if the individual seeks guidance through the passage of blood in the chair or is experiencing associated symptoms, such as fainting or lightheadedness. The clinician may ask questions to confirm the presence of bleeding, estimate the amount and rate of blood loss, identify the source and potential causes, and determine the severity of the bleeding. Diagnosis involves a complete physical exam followed by a more focused digital examination where a gloved, lubricated finger is inserted into the rectum to feel for anything unusual, such as growths, rectal fissures, or hemorrhoids. The clinician may order laboratory tests, including hemoglobin levels, to assess for anemia. An upper endoscopy and colonoscopy can also be performed, which are procedures in which the clinician inserts a small tube with a camera through the esophagus and the rectum. The procedures are typically performed under anesthesia and allow the clinician to see where the gastrointestinal bleeding is coming from. Computed tomography (CT) angiograms can be performed to visualize the origin of blood loss, and if active bleeding is present, a nuclear red blood cell scan can be used to locate the source of gastrointestinal bleeding. A nuclear red blood cell scan uses small amounts of radioactive material to mark red blood cells (RBCs) so they can be seen and tracked throughout the body.
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Hematochezia is treated by primarily restoring the individual’s blood volume to prevent hypovolemia and shock, which are medical emergencies. The second step in treatment typically involves finding the source of bleeding. Subsequently, depending on the site and underlying cause, the clinician may use a combination of pharmacologic therapy, endoscopic cauterization (i.e., a procedure that uses a heated probe to seal off bleeding vessels), and surgery. In the case of hemorrhoids, a topical treatment or suppository with hydrocortisone can help reduce the pain. IBD can be treated with drugs that control inflammation, such as aminosalicylates (ie balsalazide, mesalamine, olsalazine) or immunosuppressants (ie azathioprine and mercaptopurine).
Diverticulosis is typically treated with supportive care, such as high-fiber diets, and will likely resolve on its own. However, ischemic colitis can be self-limiting and can be treated with supportive care, such as rest and intravenous fluids. If severe, antibiotics (eg metronidazole, ciprofloxacin) can be administered to reduce the risk of infection and necrosis.
AVM and colon cancer may require the use of more invasive approaches, such as endoscopic cauterization and surgery, respectively. Necrotizing enterocolitis is usually treated by administering a feeding tube and surgery, depending on severity. Finally, a midgut volvulus can be reduced or untwisted with surgical intervention.
Hematochezia refers to the passage of blood in the stool originating from the lower gastrointestinal tract. It is often caused by inflammatory bowel disease, hemorrhoids and diverticulosis in adults; arteriovenous malformation and colon cancer in older adults; and necrotizing enterocolitis and midgut volvulus in neonates and children. A common sign of hematochezia includes bright red blood that is visible in the stool or on the toilet paper after wiping. An individual with hematochezia may also feel faint and light-headed due to the loss of blood and have associated symptoms such as abdominal pain, vomiting, or diarrhea. Diagnosis is made by a trained clinician after a thorough interview and physical exam, sometimes followed by a colonoscopy, CT scans, and nuclear red blood cell scans. Treatment depends on the cause, but usually involves restoring the blood volume that was lost, locating the source of bleeding, and stopping the bleeding. Medications and topical creams can be used to treat the underlying causes of hematochezia, and in more severe cases, surgery may be required.
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Diverticular disease. In National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved February 25, 2022, from https://www.niddk.nih.gov/health-information/digestive-diseases/diverticulosis-diverticulitis#:~:text=Diverticulosis%20is%20a%20condition%20that, call%20this%20condition %20diverticular%20disease.
Ishikawa, S., Mukai, S., Hirata, Y., Kohata, A., Kai, A., Namba, Y., Okimoto, S., Fujisaki, S., Fukuda, S., Takahashi, M., Fukuda, T., & Ohdan, H. (2020). Rectal arteriovenous malformation treated by transcatheter arterial embolization. Case Reports in Gastroenterology, 14(1):7-14. DOI: 10.1159/000505090
Liu, J.J., & Saltzman, J.R. (2009). Endoscopic hemostasis treatment: how to perform it? Canadian Journal of Gastroenterology, 23(7): 484. DOI: 10.1155/2009/857125
Walker, H.K., Hall, W.D., & Hurst, J.W. (Eds.). (1990). Clinical methods: The history, physical and laboratory examinations (3rd ed.). Butterworths. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK411/Bleeding can be defined as blood loss from the patient’s circulatory system. The causes for bleeding can be different, including cuts on the outer layer of the skin to deeper wounds and the types that occur due to accidents.
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External bleeding and internal bleeding are the two broad categories of bleeding, and within these two categories are different types of bleeding that first responders are taught about during their first aid training.
In this article, we will dive deep into the different types of bleeding to learn more about the respective symptoms.
The amount of blood in our body varies in relation to our size. A rough rule of thumb is that we have about one pint of blood per stone in body weight (0.5 liters per 7 kg), so the average adult has between 8 and 12 pints (4.5 to 6.5 liters) of blood, depending on her size.
Remember that children have less blood than adults, and as such cannot pay
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