Hematochezia Differential Diagnosis
Hematochezia refers to the passage of fresh blood per the rectum, which can be a symptom of various conditions. Here's a differential diagnosis for hematochezia, categorized for clarity:
Single Most Likely Diagnosis
- Diverticulosis: This is often the most common cause of hematochezia in adults, especially those over 40 years old. Diverticula are small, bulging pouches that can form in the digestive tract, and when they bleed, it can lead to significant hematochezia. The likelihood of diverticulosis increases with age, and it's more common in Western societies due to low dietary fiber intake.
Other Likely Diagnoses
- Hemorrhoids: These are swollen veins in the lowest part of the rectum or anus. They can cause bleeding, especially during bowel movements, leading to hematochezia. Hemorrhoids are very common and can be due to straining during bowel movements, sitting for long periods, or pregnancy.
- Anal Fissures: A tear in the lining of the anus can cause pain and bleeding during and after bowel movements. This condition is often associated with constipation or diarrhea.
- Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease and ulcerative colitis can cause inflammation and ulcers in the digestive tract, leading to bleeding. IBD can present at any age and is characterized by chronic diarrhea, abdominal pain, and weight loss, in addition to hematochezia.
- Colorectal Cancer: Although less common than other causes, colorectal cancer can cause hematochezia, especially in older adults. Risk factors include a family history of colorectal cancer, previous radiation therapy, and certain genetic syndromes.
Do Not Miss Diagnoses
- Gastrointestinal Angiodysplasia: These are vascular malformations of the gut that can cause significant, sometimes life-threatening bleeding. They are more common in the elderly and can be associated with aortic stenosis or chronic kidney disease.
- Meckel's Diverticulum: A congenital anomaly of the small intestine that can cause bleeding due to the presence of ectopic gastric mucosa. It's an important diagnosis to consider in young patients presenting with hematochezia.
- Intussusception: A condition where a part of the intestine slides into an adjacent part, potentially cutting off blood supply and causing ischemia and bleeding. It's more common in children but can occur in adults, often associated with a lead point like a tumor.
Rare Diagnoses
- Arteriovenous Malformations (AVMs): Abnormal connections between arteries and veins that can occur anywhere in the body, including the gastrointestinal tract, and cause bleeding.
- Blue Rubber Bleb Nevus Syndrome: A rare condition characterized by multiple venous malformations that can cause gastrointestinal bleeding.
- Dieulafoy's Lesion: A rare cause of gastrointestinal bleeding characterized by a mucosal ulceration with an exposed, often large-caliber, artery at its base. It can occur in any part of the gastrointestinal tract but is most commonly found in the stomach.