Blood in Stool (Hematochezia, Melena): Or something else? Differential Diagnosis

Differential diagnoses of hematochezia (blood stool, rectal bleeding)

Blood, blood-forming organs-immune system (D50-D90).

  • Blood coagulation disorder, unspecified.

Cardiovascular system (I00-I99)

  • Angiodysplasia of the intestine, unspecified – Vascular malformations of the intestine.

Infectious and parasitic diseases (A00-B99).

  • Infectious colitis (inflammation of the intestine caused by bacteria, viruses, or parasites):
    • Aeromonas spp.
    • Amoebae
    • Balantidium coli
    • Clostridium spp.
    • Crytosporidium
    • Lamblia

Mouth, esophagus (food pipe), stomach and intestines (K00-K67; K90-K93).

  • Acute mesenteric ischemia (AMI; intestinal infarction, mesenteric artery occlusion, mesenteric infarction, mesenteric occlusive disease, angina abdominalis).
  • Anal fissure – painful tear in the mucosa of the anus.
  • Angiodysplasia of the colon – mucosal or submucosal vascular excess.
  • Ulcerative colitis – chronic inflammatory disease of the mucosa of the colon (large intestine) or rectum (rectum).
  • Diverticulitis – disease of the colon in which inflammation forms in protrusions of the mucosa (diverticula).
  • Diverticulosis – protrusions in the area of the intestinal wall.
  • Small intestinal varices – dilatation of veins in the small intestine.
  • Hemorrhoids
  • Invagination – invagination of a portion of the intestine into the aborally following intestinal segment.
  • Ischemic colitis – inflammation of the mucosa of the colon due to vascular occlusion of the supplying arteries.
  • Meckel’s diverticulum – protrusion of the ileum (scimitar or hip bowel; part of the small intestine) that represents a remnant of the embryonic yolk duct (omphaloenteric duct)
  • Crohn’s disease – chronic inflammatory bowel disease; it usually progresses in relapses and can affect the entire digestive tract; characteristic is the segmental affection of the intestinal mucosa (intestinal mucosa), that is, several intestinal sections may be affected, which are separated by healthy sections from each other
  • Proctitis (rectal inflammation)
  • Rectal ulcers – ulcers in the rectum.

Neoplasms – tumor diseases (C00-D48)

  • Colorectal tumors, unspecified.
  • Tumors of the small intestine, unspecified
  • Colon carcinoma (carcinoma of the large intestine)
  • Polyps of the colon / large intestine (colonic polyps).
  • Rectal carcinoma (rectal cancer)
  • Villous adenoma (intestinal polyp)

Genitourinary system (kidneys, urinary tract – reproductive organs) (N00-N99).

Injuries, poisoning, and other sequelae of external causes (S00-T98).

  • Iatrogenic (caused by medical intervention) damage (anorectal injuries).
  • Foreign body
  • Injuries, unspecified (e.g., including child abuse).

Operations

  • State after polyectomy (polyp removal).

Other causes

  • Consumption of beet

Differential diagnoses of melena (tarry stools, pitch stools)

Blood, blood-forming organs – immune system (D50-D90).

Cardiovascular system (I00-I99)

  • Angiodysplasia of the intestine, unspecified – Vascular malformations of the intestine.
  • Aorto-intestinal fistula (AEF) (connection between the aorta and the gastrointestinal tract) – rare but life-threatening complication in the spontaneous course of an aortic aneurysm (primary form) or else as a postoperative event after prosthetic replacement of the aorto-iliac vascular segment (secondary fistula)
  • Vascular lesions (vascular injuries), unspecified.
  • Osler-Weber-Rendu disease (synonyms: Osler disease; Osler syndrome; Osler-Weber-Rendu disease; Osler-Rendu-Weber disease; hereditary hemorrhagic telangiectasia, HHT) – autosomal-dominant inherited disorder in which telangiectasias (abnormal dilation of blood vessels) occur. These can occur anywhere, but are found particularly in the nose (leading symptom: epistaxis (nosebleed)), mouth, face and the mucous membranes of the gastrointestinal tract.Because the telangiectasias are very vulnerable, it is easy to tear and therefore bleed.

Infectious and parasitic diseases (A00-B99).

Mouth, esophagus (food pipe), stomach, and intestines (K00-K67; K90-K93).

  • Acute gastritis (inflammation of the gastric mucosa).
  • Boerhaave syndrome – spontaneous rupture of the esophagus (food pipe); usually after massive vomiting.
  • Fundus varices – varicose veins in the upper part of the stomach.
  • Gastroesophageal reflux disease (synonyms: GERD, gastroesophageal reflux disease; gastroesophageal reflux disease (GERD); gastroesophageal reflux disease (reflux disease); gastroesophageal reflux; reflux esophagitis; reflux disease; Reflux esophagitis; peptic esophagitis) – inflammatory disease of the esophagus (esophagitis) caused by the pathological reflux (reflux) of acid gastric juice and other gastric contents.
  • Mallory-Weiss syndrome – clustered longitudinal (elongated) tears of the mucosa (mucous membrane) and submucosa (submucosal connective tissue) of the esophagus occurring in alcoholics, which may be associated with potentially life-threatening hemorrhage of the external esophagus and/or gastric inlet (gastrointestinal hemorrhage/GIB) as a complication
  • Esophageal varices – varicose veins in the esophagus, usually due to liver cirrhosis (irreversible damage to the liver leading to gradual connective tissue remodeling of the liver with impairment of liver function)
  • Peptic ulcer (ulcer in the gastrointestinal tract caused by hydrochloric acid):
    • Ulcus ventriculi (gastric ulcer).
    • Duodenal ulcer (duodenal ulcer)
    • Ulcus pepticum jejuni (jejunum (empty intestine; one of the three sections of the small intestine; connects to the duodenum (duodenum)).

Neoplasms – tumor diseases (C00-D48).

  • Colorectal tumors, unspecified.
  • Tumors of the small intestine, unspecified
  • Gastric carcinoma (stomach cancer)
  • Colon carcinoma (colon cancer)
  • Esophageal carcinoma (cancer of the esophagus)

Genitourinary system (kidneys, urinary tract – sex organs) (N00-N99).

Injuries, poisoning, and other consequences of external causes (S00-T98).

  • Injuries, unspecified

Other causes

  • Foreign body
  • Blueberries
  • Licorice

Medicines

  • Anticoagulants (drugs that inhibit blood clotting).
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) result in a three- to fivefold increase in the risk of upper gastrointestinal tract complications (upper GI bleeding, perforation/breakthrough, ulcer/ulcer); complications are dose-dependent
  • Iron supplements
  • Coal preparations
  • Bismuth preparations
  • See also drug side effects, under:
    • “Bleeding due to medications”
    • “Platelet dysfunction due to drugs”