4. PAIN
Painful-anorectal lesions, Ca anal canal, piles
Painless- polyps, Meckel’s diverticulum
PAIN IN RELATION TO DEFEACATION
On defeacation- piles, Ca anal canal
After defeacation- solitary rectal ulcer
POLYPS
5. TENESMUS
rectal Ca, ulcerative proctitis, irradiation proctitis
ABDOMINAL PAIN AND BLOODY DIARRHEA
IBD, infectious diarrhea, Ca colon
6. NATURE OF BLOOD AND STOOLS
Anorectal bleeding- straining and passing of hard
stools, with dripping of blood
Piles- blood may splash or drip after defeacation
Ca anal canal and rectum- streaking of blood on
stools
MALIGNANCY
7. COLOR OF STOOLS
Brown stools streaked with blood- rectosigmoid or
anal cause
Large volume of bright red blood- colonic source
Black stools- upper GI bleed
Maroon stools- small intestine or right colon
Bright red blood- anal canal
8. Bleeding from other sites- indicates systemic
disease/ drug induced bleeding
Weight loss, anorexia, abdominal pain, vomitting –
malignancy
Sexual abuse- trauma to anal canal
12. CLINICAL EVALUATION
history and physical examination are not usually
diagnostic of the source of GI bleed
Examine all system in detail with special reference
to per rectum examination
13. Patients with massive LGIB usually present with
bright red blood per rectum
hypotension
markedly reduced hematocrit
14. Patients with mild bleeding who may present with
intermittent passage of maroon-colored stools.