Monday, 2 December 2013

Hemorrhaging: Hematochezia (rectal bleeding) - Diagnosis

Hemorrhaging is also known as bleeding or abnormal bleeding as a result of blood loss due to internal.external leaking from blood vessels or through the skin.
Hematochezia (rectal bleeding)
Hematochezia is defined as a condition of the passage of bright red, bloody stool. In most cases it is an indication of hemorrhoids (swollen veins in and around the rectum) or diverticulitis, a common digestive disease particularly found in the large intestine, as a result of infection or inflammation.
4.1. Colonoscopy and arteriography
In the study of Diagnosis and treatment of hematochezia: guideline for clinical practice, DR. Wandono H. at the Department of Internal Medicine, Hajj Hospital Surabaya wrote that there are difficulties in clinical practice to find the cause and making the diagnosis and therapy for hematochezia. Fortunately, the progress and development in medical technology, especially colonoscopy and arteriography, has assisted in clinical practice(12).

4.2. Blood test
The aim of blood test is to determine the hemoglobin concentration, coagulation and and tests of liver and renal function are useful in checking for factors that may exacerbate bleeding.
4.3. In stable patients
a. In younger patients
If the physical examination or anoscopy reveals a bleeding hemorrhoid or other cause of local anal pathology, no other test is necessary as the possibility of colon cancer is fewer than 1% in those younger than age 30 years.
b. In older patients
80% of colorectal malignancies are found in patients older than the age of 50 years. Even if a local lesion such as a hemorrhoid is discovered. Twenty-seven percent of patients with carcinoma of the rectum and 10% of those with carcinoma of the sigmoid have been noted to have coincidental hemorrhoids. Most patients older than the age of 40 years with rectal bleeding are candidates for colonoscopy.
4.2, 4.3,(13)
4.5. Computed tomography (CT) angiography
CT angiography is an accurate, cost-effective tool in the diagnosis of acute GI bleeding and can show the precise location of bleeding, thereby directing further management, according to the study by  Shanghai Jiao Tong University School of Medicine(14).
4.6. Etc.
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