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Bleeding per rectum

Bleeding per rectum. It may be: 1 -Fresh (Haematochezia) 2 -Melaena(black tarry stool) 3 - Occult bleeding (can not be manifested clinically ). ( 1) HAEMATOCHESAIA (Fresh bloo d. Causes: 1-Anal causes : -Haemorrhoids -Anal fissure -AnaL fistula -Neoplastic -Trauma.

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Bleeding per rectum

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  1. Bleeding per rectum

  2. It may be:1-Fresh (Haematochezia)2-Melaena(black tarry stool)3- Occult bleeding (can not be manifested clinically)

  3. (1) HAEMATOCHESAIA (Fresh blood Causes: 1-Anal causes : -Haemorrhoids -Anal fissure -AnaL fistula -Neoplastic -Trauma

  4. 2-Colorectal-Congenital :FPC or solitary polypInflammatory: -Acute bacillary dysentery -Amoebic dysentery -Bilharzial colitis-Ulcerative ColitisVascular:Ischaemic colitisDivercular disease of the colonNeoplastic:Benign and malignant colorectal neoplasm Angiomatous malformation :AngiodysplasiaRectal prolapse3-Generalized causes:as thrombocytopenia or leukemia

  5. Causes of melaena : 1-Swallowed blood from upper GIT bleeding due to: 1-Oesophageal causes 2-Gasteric causes 3-Duodenal causes 4-Small intestinal causes 5-General causes

  6. Causes of occult blood 1-GIT malignancies 2-Reflux oesophagitisand oesophagitis 3-Peptic ulcer 4-Gastritis 5-GIT polyps

  7. Clinical features I)History 1-In haemorrhoids 2-Familial polyposis 3-Acute dysentery 4-Ulcerative colitis 5-Colorectal cancer 6-Diverticulosis and vascular malformation difficult to be diagnosed

  8. Investigation 1-Exclude : -Upper GIT bleeding -Generalized causes 2-Stool analysis 3-Proctoscopy 4-Sigmoidoscopy 5-Lower endoscopy 6-Isotope scanning by 99mTc 7- Selective angiography Through the superior or inferior mesenteric artery 8- Barium enema for colonic cancer 9-Laparotomy 10-Diagnosis of occult blood -Upper and lower endoscopy -Barium meal and enema - CT,MRI ,Ultrasound -Special tests :Haemoccult test -Benzidin test

  9. Treatment 1-For Massive bleeding -Resuscitation -90% stop spontaneously elective -If continues: -By selective angiography to inject vasopressin or gel Foam (embolizing substance)at the site Of bleeding -Or by colonoscopy if discovered angiodysplasia by diathermy or laser

  10. -If continues Surgical –Failure of other methods - -Blood loss more than 2.5 /48 hours Shows the source of bleeding and do : -Segmental resection Or even total colectomy 2- Small occult blood : By elective aetiological treatment

  11. Massive blood loss -Diverticulosis -Ulcerative Colitis -Ischaemic colitis -Angiodysplasia -Massive upper GIT bleeding -Meckel’sdiverticulum -FAP -Generalized blood disease

  12. Common Anorectal Symptoms Conditions Associated with PruritusAni Mechanical factors Chronic diarrhea Chronic constipation Anal incontinence Soaps, deodorants, perfumes Over-vigorous cleansing Hemorrhoids producing leakage Prolapsed hemorrhoids Rectal prolapse Anal papilloma Anal fissure Anal fistula Tight-fitting clothes Allergy to dyes in toilet paper Dermatologic conditions Psoriasis Seborrheic dermatitis Intertrigo Atopic dermatitis Lichen planus Contact dermatitis

  13. Infections Intertrigo (Candida) Herpes simplex virus Human papillomavirus Pinworms (Enterobius) Scabies Local bacterial abscess Gonorrhea Syphilis Diabetes mellitus Hyperbilirubinemia Leukemia Aplastic anemia Thyroid disease Skin sensitivity from foods Medications ColchicineQuinidine Systemic illness Idiopathic

  14. Treatment of pruritis ani Successful treatment of pruritusani depends on recognizing the condition Many patients scratch excessively during sleep and unaware of their action.are Antihistamine taken before bedtime is often helpful because it is an antipruritic and sedative Topical corticosteroid are helpful but may cause thinning of the perianal tissues and leads to more pruritis personal hygiene Lidocaine gel l&local anesthetic Identify and treat the secondary cause

  15. Anal pain Pain during bowel movements that is described as "being cut with sharp glass“ usually indicates a fissure The acute onset of pain with a palpable mass is almost always due to a thrombosed external hemorrhoid Anal pain accompanied by fever and inability to pass urine signals perineal sepsis and is a medical emergency

  16. Causes of anal pain Thrombosed external hemorrhoids Anal fissure Anal abscess Herpetic ulceration/other sexually transmitted disease Crohn’s ulceration and inflammation Anal,rectal or pelvic cancer Lymphoma or leukemia atypical causes of anal fissure or uLcer Syphilis Tuberculosis Leukemic infiltrate Carcinoma Herpes Crohn’s disease

  17. Proctalgia fugax Patients with proctalgia fugax experience severe episodes of spasm-like pain that often occur at night. Proctalgia fugax may only occur once a year or may be experienced in waves of three or four times per week. Each episode lasts only minutes. but the pain is excruciating and may be accompanied by sweating, pallor and tachycardia. Patients experience urgency to defecate, yet pass no stool. No specific etiology has been found, but proctalgia fugax may be associated with spastic contractions of the rectum or the muscular pelvic floor in irritable bowel syndrome.

  18. Thank you

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