From the Research
Introduction to Hematochezia
Hematochezia, the passage of bright red blood per rectum, is a common clinical presentation that requires a rational and concise approach to determine the cause and provide appropriate management 1.
Patient Assessment
The initial assessment of a patient with hematochezia involves hemodynamic evaluation and risk stratification, followed by a focused history and physical examination 1.
Disposition of Patients with Normal Hemoglobin and Stable Blood Pressure
For patients with hematochezia, normal hemoglobin, and stable blood pressure, the disposition depends on various factors, including the presence of other symptoms, medical history, and the results of initial evaluations.
Outpatient Management
Patients with scant hematochezia and no other alarming symptoms may be managed as outpatients, with a follow-up colonoscopy to rule out significant colonic lesions 2.
Inpatient Management
However, patients with significant bleeding, instability, or other concerning features require inpatient management, including close monitoring, laboratory tests, and potentially, endoscopic interventions 3, 4.
Diagnostic Evaluation
The diagnostic evaluation of patients with hematochezia typically involves colonoscopy, which is recommended for patients aged 50 years or older 3.
Upper Endoscopy
In cases where the bleeding source is not identified on colonoscopy, upper endoscopy or capsule endoscopy may be considered to evaluate the upper gastrointestinal tract 4.
Treatment and Management
The treatment and management of patients with hematochezia depend on the underlying cause, which may include diverticulosis, vascular ectasias, ischemic colitis, or colorectal cancer.
Medical Management
Medical management is often sufficient for patients with ischemic colitis, while surgical intervention may be necessary for those with severe bleeding or complications 5.
Surgical Intervention
Surgical patients and those who are not surgical candidates tend to have worse outcomes, including higher complication rates and mortality 5.
Conclusion
In conclusion, the recommended disposition for a patient with hematochezia, normal hemoglobin, and stable blood pressure depends on a thorough evaluation of the patient's symptoms, medical history, and the results of initial assessments. A step-wise approach, including hemodynamic assessment, risk stratification, and endoscopic evaluation, helps determine the cause and provide appropriate management of these patients 1.
Key Considerations
- Patients with hematochezia require a thorough evaluation to determine the underlying cause
- Colonoscopy is recommended for patients aged 50 years or older
- Upper endoscopy or capsule endoscopy may be considered in cases where the bleeding source is not identified on colonoscopy
- Medical management is often sufficient for patients with ischemic colitis, while surgical intervention may be necessary for those with severe bleeding or complications
- Patients who are not surgical candidates tend to have worse outcomes, including higher complication rates and mortality 5
Differential Diagnoses
- Diverticulosis
- Vascular ectasias
- Ischemic colitis
- Colorectal cancer
Caveats
- Patients with significant bleeding, instability, or other concerning features require inpatient management
- The presence of other symptoms, medical history, and the results of initial evaluations influence the disposition of patients with hematochezia, normal hemoglobin, and stable blood pressure.