Blood in the stool is defined as bleeding from the digestive tract with blood being expelled through the anus. Blood in the stool can be bright red, dark red or black in color. A small amount of bleeding that does not cause a change in stool color and that can only be determined by an occult blood test is called occult blood.
The common causes of blood in the stool disease are as follows.
1, Diseases of the GI tract itself, the most common, such as bleeding from ruptured esophageal/basal varices, ulcers and inflammation of the stomach and intestinal tract, parasitic infections, tumors (including polyps and cancer), hemorrhoids, intestinal overlap, anal fissures, and dry stool abrasions.
2.Diseases of systems other than the gastrointestinal tract, such as blood diseases, acute infectious diseases, vitamin deficiencies, poisoning or toxic effects of drugs, etc., require a detailed medical history.
3.Blood in stool in children, mostly caused by intestinal polyps, bright red, painless, blood and stool do not mix; also seen in bacterial dysentery, intestinal stasis, hematologic diseases, etc. In adults, blood in the stool is mostly caused by hemorrhoids, anal fistula, anal fissure, intestinal polyps, intestinal cancer, inflammatory bowel disease, etc.
Clinical manifestations of blood in the stool disease, but also the initial diagnosis and treatment of the condition, to narrow the scope of the disease, as follows.
1, fresh blood stool more
For acute (immediate) bleeding, the blood flows out of the blood vessels for a short time and is discharged via the anus with the stool, or directly after the stool. The appearance of the blood flow resembles traumatic bleeding, bright red or purple-red or dark red in color, and can coagulate into a blood clot after a little time. It is often seen in the following diseases.
(1) Hemorrhoids: External hemorrhoids and mixed hemorrhoids of all stages can cause fecal bleeding, usually with fresh blood in the stool or dripping blood after the stool. External hemorrhoids usually do not bleed in the stool.
(2) Intestinal polyps: Painless fecal bleeding. The amount of bleeding varies. Generally, the blood does not mix with the stool, or the polyp may mix with the stool if the polyp is in a high position and the number is large.
(3) Rectal prolapse: bleeding during defecation may occur after a long period of illness.
(4) Anal fissure: blood in stool, bleeding in the form of blood attached to one side of the surface of stool, not mixed with stool, and some patients drip blood after stool.
2.Pus blood/mucus blood stool
That is, there is both pus (mucus) and blood in the excreted stool. Pus (mucus) blood stool is often seen in the rectum or colon tumors and inflammatory diseases. The following diseases are commonly seen.
(1) rectal cancer: the blood is fresher or darker red, and there may be mucus in the stool, often mixing blood, mucus, and stool.
(2) colon cancer: bleeding in the stool gradually occurs with the prolongation of the disease, mostly bloody stools containing pus or mucus, with darker blood color.
(3) Ulcerative colitis: mucus stools or pus and blood stools, accompanied by pain in the left lower abdomen or lower abdomen.
(4) intestinal infectious diseases: such as bacterial dysentery, amoebic enteropathy, etc.
3, black stool also known as tarry stool
The stool is black or brown-black. It is one of the most common symptoms of upper gastrointestinal bleeding. If the amount of bleeding is small, and the bleeding rate is slow, the blood in the intestine for a longer period of time, the stool is black; if the amount of bleeding is large, in the intestine for a shorter period of time, the blood discharged is dark red; bleeding is particularly large, and quickly discharged can also be bright red.
4, occult blood stool
A small amount (trace) of gastrointestinal bleeding will not cause a change in stool color, but only a positive fecal occult blood test, called occult blood stool. All diseases causing gastrointestinal bleeding can occur occult blood stools, commonly ulcers, inflammation and tumors. The stool occult blood test detects a small (trace) amount of blood in the stool. Regular stool occult blood testing is an important way to screen for colorectal tumors (primary screening).
5.Concomitant symptoms
(1) Anal and perianal lesions: bright red blood in stool, unbearable anal pain, or swelling with hemorrhoid nucleus, or accompanied by anal fissure.
(2) Upper gastrointestinal tract diseases: vomiting blood is usually accompanied by black stool, and there can be bloody stool when the bleeding is large and fast.
(3) Lower gastrointestinal tract diseases: The accompanying symptoms vary depending on the primary cause of the bleeding.
Common tests for blood in stool are.
(1) Blood, urine and stool routine; fecal occult blood test can be performed if there is no visual blood in the stool but occult blood cannot be excluded. Depending on the primary cause, fecal bacterial culture and parasite detection can be performed; biochemical tests, including liver and kidney function, electrolytes, blood glucose, blood lipids, coagulation function, tumor markers, etc.
2.Imaging examination of abdominal ultrasound, CT, MRI, PET-CT, gastro/intestinal microscopy, small intestine microscopy, capsule endoscopy, duodenoscopy, etc. to clarify the location and nature of gastrointestinal lesions.
3.Bone marrow aspiration examination to exclude hematologic diseases.
4.Anal finger diagnosis helps to detect rectal tumor.
In the treatment of blood in stool, the primary measure is to maintain the patient’s hemodynamic stability, restore blood volume, and control acute bleeding as soon as possible.
(A) First aid treatment in case of massive blood in stool
1.Establish effective intravenous infusion channels, follow medical prescriptions for various hemostatic drugs, and input blood and fresh plasma to replenish blood volume and maintain effective circulating blood volume.
2. Fasting, oral care twice a day during fasting to keep the mouth clean and odorless.
3.Insert a gastric tube, keep it open, and inject ice saline with norepinephrine into the gastric tube to stop bleeding as prescribed by the doctor.
(B) Monitor changes in condition
Regularly measure the patient’s vital signs, including body temperature, pulse, inspiration, blood pressure, and state of consciousness, and record the number, amount, and color of blood in stool. Pay attention to the concomitant symptoms when the patient has blood in the stool, and observe whether the patient has early manifestations of shock, and take effective treatment measures in time if problems are found.
(iii) Daily care
Patients should rest in bed and reduce activities when they bleed heavily. Nursing staff should strengthen rounds to meet the basic living needs of patients and keep the patient’s bed unit clean and dry, so that the patient’s comfort can increase and facilitate disease recovery.
(iv) Psychological care
Create a quiet and neat recuperation environment and reduce visitors. Nursing staff should show more care and consideration for the patients, listen to them carefully and give them full understanding in order to relieve the psychological reactions such as tension, anxiety and fear caused by massive bleeding.
(V) Health education
1.Teach patients and their families how to observe blood in stool, such as recognizing the color and nature of stool, etc.
2.Give the patient health education about medication, so that the patient can repeat the purpose of taking medication and the importance of taking medication on time.
3.Rational diet, small amount and many meals, avoid stimulating food, eat regularly to protect the gastric mucosa.
4.Prohibit smoking and alcohol to reduce mucosal irritation of the gastrointestinal tract. In the case of stable patient condition, the corresponding examination is performed to clarify the diagnosis and timely symptomatic treatment, such as
1, endoscopic treatment: it is one of the effective means of treatment for lower gastrointestinal bleeding. Diffuse bleeding can be stopped by spraying drugs such as norepinephrine or thrombin; for limited bleeding, electrocoagulation, laser, microwave and sclerotherapy injection are available.
2.Arterial embolization treatment: during selective angiography, inject gelatin sponge through catheter to embolize bleeding artery to achieve hemostasis.
3.Surgical treatment is feasible for malignant tumor, arteriovenous malformation, Meckel diverticulum and other surgical resection treatment.