There is a hemorrhoid patient in his 50s who has always been relatively hardy, but in the past two years he often found some dark red blood on the surface of the stool, he always thought it was bleeding hemorrhoids, so he did not pay much attention to it until an occasional physical examination, colonoscopy found a surface erosion of the upper rectum swelling, almost full of the intestinal cavity, after biopsy pathology showed that it was rectal adenocarcinoma. When the doctor told him that he should come for colonoscopy earlier, he looked very regretful and let out a long sigh “I didn’t know ……” I. Blood in the stool Visible and invisible blood in the stool, as the name suggests, is blood in the stool, the medical science will see blood in the stool with the naked eye The blood in the stool that can be seen with the naked eye is called visible blood in the stool, while the one that cannot be seen with the naked eye is called fecal occult blood. Blood in stool may be a sign of digestive tract cancer, and sometimes it is the only sign of early stage cancer.
1. Visible: black stool Apart from blood dripping on the surface of stool, the most common form of blood in stool is black stool. After bleeding from the digestive tract, the outflowing blood decomposes iron in the esophagus, stomach and intestines, which combines with sulfide produced by bacteria to form iron sulfide and becomes black. When the amount of bleeding is more than 50 to 70 ml (a small teacup), black stool can appear; and when the stool is black and shiny like the kind of tar used for paving, it means that the amount of bleeding is about 100 to 500 ml (a bowl to a bottle). immediately to the hospital emergency room.
2, invisible: occult blood occult blood is blood loss is too small or blood has been decomposed and can not be identified by the naked eye stool blood, must be found through the “fecal occult blood test”, but occult blood does not mean that the amount of bleeding, some patients with upper gastrointestinal tract (such as the stomach, biliary tract) bleeding, although the amount of bleeding, but blood in the long journey from the esophagus to the anus The journey has been broken down into various fragments by the digestive juices, and only through the occult blood test can we find traces of it.
Generally speaking, if the amount of digestive bleeding in a day is more than 5 ml (one test tube), the occult blood will be positive, while the color of the stool can be unchanged.
It should be reminded that a weakly positive occult blood test (a “+” on the test sheet) is not necessarily blood in the stool, but also in the diet of animal meat (mainly red meat), blood (iron in meat and blood can also form black iron sulfide in the human intestine) or taking iron-containing drugs, which can also cause the illusion of occult blood. In addition, these foods or drugs taken in excess, there may be caused by “false black stool”, mostly dark gray, dark black, will not be accompanied by any other uncomfortable symptoms.
Second, the source of blood in the stool “three-stage” blood in the stool is often just a manifestation of bleeding in the digestive tract, especially in the lower gastrointestinal tract (from the upper part of the small intestine to the anus). In our lower gastrointestinal tract, these “real culprits” are generally infested in three segments.
1, anal segment The first to be included is the anal disease “gang”, because they are the most common repeat offenders of blood in the stool. Among them, the number of hemorrhoids “crime” the highest frequency. The hemorrhoid is a disease with a very high incidence, as the saying goes, “ten men and ten hemorrhoids, ten women and nine hemorrhoids”.
Anal fissures and fistulas are two other more common diseases of the perianal area that can present with small drops of blood after a stool, usually accompanied by more intense pain during or after a stool, and fistulas are also seen with recurrent flowing pus openings around the anus, surrounded by redness, swelling, and hot pain. It is important to emphasize that other causes of blood in the stool cannot be ruled out when there are anal diseases, and some tests are needed to check them out.
Colorectal segment Colorectum is what people usually call “large intestine”, which is a part with high incidence of cancer. Colorectal cancer is a common cause of blood in the stool, accounting for 30% to 50% of the cases of blood in the stool in foreign countries, especially for the elderly.
In addition to blood in stool, symptoms of colorectal cancer may also include lower abdominal pain, diarrhea, constipation, thinning of stool, snot-like mucus in stool, urgency and heaviness, etc. In advanced stage, patients may also show anemia such as emaciation or pallor, dizziness, etc. Intestinal polyp disease is also a common cause of blood in the stool, especially for children and adolescents. Bleeding from intestinal polyps is usually small, often a small amount of blood attached to the surface of the stool, with no other symptoms. Most intestinal polyps can be electrically removed endoscopically without hospitalization or surgery.
Colonic vascular dysplasia, also known as colonic vasodilatation, is a common cause of acute or chronic blood in the stool in people over 60 years of age.
Acute and chronic enteritis is also a common cause of blood in the stool. Patients with chronic colitis also often have diarrhea, stomach pain and other discomforts, and are generally in poor physical condition, lethargic, with prolonged low-grade fever, etc. Some may also have depression and other psychiatric symptoms. Acute enteritis, such as dysentery and amebiasis, is usually caused by an unclean diet, and may also present with blood in the stool and also with significant diarrhea. In the elderly, ischemic enteritis can be a cause of bloody diarrhea, and the disease is also seen in young women who often take birth control pills.
3, small intestine segment The small intestine is arguably the longest organ in the body, about 4 or 5 meters long. Many blood in the stool comes from the small intestine, the most common is small intestinal tumors, malignant slightly less than benign, accounting for about 2.5% of the entire intestinal tumors. Bleeding is often the first and only symptom of small intestine tumor. Elderly people with small intestine tumor combined with bleeding should be alert to the possibility of malignancy.
For identifying the “three axes” of blood in stool, doctors generally have the most important “three axes” to check the list of “suspects” above blood in stool and find out the real culprit.
1, anal finger examination “the first axe”, the most simple and most important to be the anal finger examination. Do not underestimate the “one finger”, it can be said that the rectum within 8-10 cm from the anus is its “jurisdiction”, relying on it, 80% of rectal cancer can be diagnosed; various common diseases, such as hemorrhoids, anal fissures, rectal polyps, low The “jurisdiction”, alone, 80% of rectal cancer can be diagnosed; various common diseases, such as hemorrhoids, anal fissures, rectal polyps, low rectal cancer, etc., can also be “a touch to know.
2, anal peep Anal peep “second axe” – anal peep, also known as anoscope, is also the anorectal department necessary “detection weapon”. During the examination, the doctor will be coated with lubricant mirror, slowly from the anus into the rectum, the core will be removed, the outer casing gradually outward exit, in the spotlight under the direct view of the rectum, the anal canal mucosa. The “One Finger Magic” relies on the sense of touch, while it relies on vision, and the two just complement each other, and is an important means of examining internal hemorrhoids, anal fissures, rectal polyps, and cancer.
If the first two axes are not able to find the “real culprit”, then we have to use the most powerful “third axe” – gastrointestinal endoscopy, mainly gastroscopy, enteroscopy.
3, gastrointestinal endoscopy Gastroscope shape is a bit like a common weapon in martial arts novels “whip”, examination, under the operation of the doctor gastrointestinal mirror is like a whip with eyes, like a snake winding into the gastrointestinal tract, will see the high-definition image in real time on the monitor for the doctor to observe. Gastroscopy is valuable for diagnosing patients with small to moderate amounts of blood in the stool.
The power of gastroscopy also lies in its ability to “scout” for disease, but also has the ability to “work on the spot”, and can endoscopically stop bleeding directly by electrocoagulation, hemostatic drug spray, sclerosing dose injection, and small vessel titanium clips. In the case of intestinal polyps, they can also be removed “in situ”.
Blood in stool is a very common symptom, when found should not be nervous panic, should not let down the vigilance, should promptly go to the hospital, through the doctor’s “three axes” examination, to find out that “the real culprit”, to get targeted treatment, to get good The treatment effect.