Hemorrhage Of Rectum And Anus Differential Diagnosis Table

Hemorrhage Of Rectum And Anus Differential Diagnosis Table:

Hemorrhage of the rectum and anus (rectal bleeding) is a condition in which patients discover blood on toilet paper; there can be pain and itching along with bleeding as well.
Most cases of rectal bleeding arise from an underlying condition that can be mild like hemorrhoids to life-threatening conditions like colon cancer.
The source of rectal bleeding can be from any place along the GIT, small intestine, colon, and rectum.
Extensive diagnostic tests are needed for rectal bleeding, starting from a colonoscopy to other imaging tests like CT and ultrasound to determine the exact underlying problem causing the bleeding.

How to Distinguish Hemorrhage of Rectum and Anus from Other Conditions

Distinguish Colorectal Cancer from Hemorrhage of Rectum and Anus – Diagnosis

Colorectal cancer is the malignant overgrowth of colon or rectum cells or both; this usually affects people in old age. It commonly appears first as colon polyps, which are asymptomatic and many patients don’t realize they have it until it transforms into cancer. This is why routine screening is important.

• Colonoscopy is the main diagnostic test for colorectal cancer; a tissue biopsy is taken in the procedure for histopathological examination and confirmation of diagnosis.
• Blood tests to see the level of protein called carcinoembryonic antigen (CEA) can help in diagnosis; it’s only positive for 60% of patients but can help in detecting recurrence of the tumor and response to treatment.
• Other imaging tests like CT and MRI can help detect any abnormalities in the colon and in identifying the size of the tumor as well.

Distinguish Hemorrhoids from Hemorrhage of Rectum and Anus – Diagnosis

Hemorrhoids are a condition in which blood vessels on the anus become swollen; this causes pain and difficulty in defecating. Most often, people may experience bleeding too with hemorrhoids; it’s a very common condition that affects most people, especially women during pregnancy and childbirth.

• Physical examination to examine swollen blood vessels.
• Digital rectal examination when the doctor inserts a lubricated gloved finger to examine blood vessels and look for any inflammation and swelling.
• Some endoscopic procedures like anoscopy, sigmoidoscopy, and colonoscopy are sometimes used if other physical examinations failed.

Distinguish Diverticulosis from Hemorrhage of Rectum and Anus – Diagnosis

Diverticulosis is a condition in which there are pockets or pouches forming on the lining of the intestine, especially the colon. Diverticulosis is a very common condition and in most cases it’s completely asymptomatic, although there’s a chance that the diverticula become inflamed or infected; it’s then called diverticulitis and it can cause symptoms of abdominal pain, nausea, and vomiting.

• CT scan is the easiest and fastest way to diagnose diverticulosis; CT will give a clear image of the presence of diverticulosis.
• Sometimes a blood and stool test may be needed to rule out the presence of infection or inflammation.
• Rarely, a colonoscopy is needed to have a closer look and see if there are complications from diverticula.

Distinguish Colorectal Polyps from Hemorrhage of rectum and anus – Diagnosis

Colorectal polyps are the growth of tissues from the lining of the colon or rectum; usually colorectal polyps are asymptomatic and most people don’t recognize they have it. Polyps have a high risk of turning cancerous especially polyps with larger size, that’s why routine screening for colorectal polyps is recommended especially in older ages.

• Colonoscopy is the most used diagnostic test for examining polyps and they can be used to remove polyps as well; a tissue biopsy can also be taken to rule out malignancy.
• Virtual colonoscopy is an alternative method for colonoscopy; it can help in detecting and confirming the presence of polyps.
• Fecal occult blood test can also be used to detect the presence of any blood in stool; this can refer to the presence of polyps or cancer.

Distinguish Inflammatory Bowel Disease (IBD) from Hemorrhage of Rectum and Anus – Diagnosis

Inflammatory bowel disease is a chronic disease that causes inflammation in the GIT or intestine; it has two types: ulcerative colitis or Crohn’s disease. The exact cause of IBD is not known but it’s believed to be an autoimmune disease; they cause symptoms of abdominal pain, diarrhea, and weight loss.

• The combination of endoscope and colonoscopy is the best for detection of Crohn’s disease and ulcerative colitis; biopsies can be taken too.
• Fecal calprotectin may be used for initial investigation but it can’t be used for confirming diagnosis.
• Other imaging tests like MRI, CT, and ultrasound have also been used to diagnose IBD and look for any other complications that may happen because of the disease.
• Stool tests may be used in initial investigation to see other causes of diarrhea and detect any blood in stool.

Distinguish Anal Fissures from Hemorrhage of Rectum and Anus – Diagnosis

Anal fissures are a crack or a tear in the moist layer lining the anus; this can happen due to constipation or straining. This can cause pain and bleeding from the crack that can be really painful and discomforting for the patient. Usually, it’s not a serious condition and the fissure heals by itself or with simple topical treatments.

• Physical visual examination by the doctors where they can see the fissure themselves.
• Digital rectal examination can be used for examination of the fissure itself and extent of crack or tear itself.
• Rarely, a colonoscopy or anoscope can be used if physical examination failed to detect fissures.

Distinguish Gastrointestinal Bleeding from Hemorrhage of Rectum and Anus – Diagnosis

Gastrointestinal bleeding is a symptom rather than a disease itself; it usually reflects an underlying problem that may arise from any place in GIT. It can be caused by ulcers, IBD, anal fissures, or even cancer. GIT bleeding can lead to vomiting of blood which in rare cases can lead to hypovolemic shock.

• Upper endoscope is used to detect any ulcers, GERD, esophageal problems that may have caused GIT bleeding.
• Upper GI series; which is X-ray images with contrast (barium) is used to give various images of GIT and detect any underlying problem.
• A colonoscopy is needed to examine the colon and rectum and confirm or rule out any damage in the large intestine.
• Fecal occult blood test is used to detect any hidden blood in stool.

“Since gastrointestinal bleeding is caused by an unknown underlying condition, it requires extensive diagnosis to know the exact disease.”

Distinguish Proctitis from Hemorrhage of Rectum and Anus – Diagnosis

Proctitis is an inflammation in the lining of the rectum; this usually happens from a bacterial infection or due to another condition like IBD. Proctitis can cause uncomfortable sensations and pain, bleeding occurs too during defecation.

• Proctoscopy is usually done for diagnosis if initial investigation suggests proctitis; it’s a hollow thin tube that examines the rectum.
• Flexible sigmoidoscopy can also be used; it will examine the rectum and part of the colon called the sigmoid colon. Sometimes a biopsy is taken to help in investigations.
• Blood tests can be used for the prognosis of the disease and response to treatment; CRP and ESR will usually be elevated indicating the presence of inflammation.
• Stool tests are also needed to detect the presence of any viral or bacterial infection that may have caused proctitis; it also can help in detecting the presence of blood in stool.

Distinguish Ischemic Colitis from Hemorrhage of Rectum and Anus – Diagnosis

Ischemic colitis is a condition caused by blocked blood supply to the large intestine; this can be caused mainly by low blood pressure but other conditions like blood clots can cause blocked blood vessels leading to the cutting of blood supply. Symptoms of ischemic colitis can be confused with other GIT conditions, since the most common symptom is abdominal pain.

• Endoscopic procedures like colonoscopy and sigmoidoscopy can examine the colon and rectum. Possibly, a biopsy may be taken too to give more information.
• Blood tests like CRP and WBCs will usually be elevated, showing signs of inflammation.

“X-ray and other imaging tests without contrast may not show ischemia and may not help in diagnosis.”

Distinguish Angiodysplasia from Hemorrhage of Rectum and Anus – Diagnosis

Angiodysplasia is a condition in which blood vessels of GIT become dilated and swollen; this may cause bleeding along GIT where angiodysplasia occurred. The exact cause of angiodysplasia is not known but maybe because of aging or maybe an underlying condition like aortic stenosis.

• Colonoscopy is used for the diagnosis of angiodysplasia, since the most common place for the occurrence of angiodysplasia is the colon.
• Esophagogastroduodenoscopy (EGD) is used if angiodysplasia is located in the upper GIT.
• Angiography is the most diagnostic test for angiodysplasia since it’s used specifically to examine blood vessels.
• Stool test may be needed to check for blood in stool.
• CBC is used to check HG level and rule out anemia because of bleeding.

“In most cases, angiodysplasia is found as an incidental finding during investigation for unexplained anemia.”

Distinguish Rectal Trauma from Hemorrhage of Rectum and Anus – Diagnosis

Rectal trauma happens due to a physical injury to the rectal area; this maybe a gunshot or a blunt trauma, this usually causes bleeding and pain, treatment varies according to the severity of trauma.

• Physical visual examination can be done by the doctor to see injury of the rectum.
• Digital rectal examination can be used also for examining the injury and extent of it.
• Proctoscopy or colonoscopy are also used to give more information on the damaged rectum.
• Other imaging tests like CT and MRI can be used too.

Important Red Flags in Hemorrhage of Rectum and Anus

Hemorrhage of rectum and anus can range in severity according to the underlying condition; it can be mild as anal fissures and hemorrhoids or a serious condition like colorectal cancer.
Presenting with anemia is the most common alarming sign in hemorrhage of rectum and anus; it reflects that the bleeding was severe leading to a drop in iron HG in blood.
Another red flag is vomiting of blood too along with rectal bleeding; this may indicate internal bleeding and lead to hypovolemic shock.
Although abdominal pain and weight loss are common symptoms, they are considered as red flags with rectal bleeding because it may be caused by colon cancer.