Talk:Blood in stool

Wiki Education Foundation-supported course assignment

This article is or was the subject of a Wiki Education Foundation-supported course assignment. Further details are available on the course page. Student editor(s): Sarahguess5. Peer reviewers: Vway2209.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 15:58, 16 January 2022 (UTC)

After drinking

Is anybody going to cover that a common phenomenon is that people find blood in their stool after a night of drinking? I've heard of this before, and when you google it a lot of people report the same phenomenon. I found one explanation that said that your blood flow to your liver gets constricted as your liver tries to process the blood to remove alcohol, and then there is a back up of blood, and that back up goes to the rectum, since a third of the arteries from your rectum/lower intestine go to your liver, and the back up of blood sometimes leaks and causes blood in the stool. — Preceding unsigned comment added by 108.170.95.180 (talk) 14:51, 22 August 2012 (UTC)

Black pudding?

• Can eating black pudding cause 'blood in stool'? Anthony Appleyard (talk) 17:51, 18 July 2010 (UTC)

Reverts - thanks

Thanks for the reverts. I edited too hastily and wasn't aware of the disambig. guidelines. Kind regards, LT90001 (talk) 21:55, 21 September 2013 (UTC)

Editing/Revamping Page

I plan to add to this article and revamp the list of causes given under blood in stool. This is a broad category, so in order to do it justice, I will approach several different areas.

Resources The page is currently out of date, with several resources dating from prior to 2010, with some even prior to 2000. I will update these resources, to ensure that the information reflected is more accurate. Additionally, as new information is added, my goal will be to only use resources within the last five years for primary information.

Introduction Currently the introductory paragraph quickly brushes over some topics rather quickly, which are important distinctions in the types of blood found in stool. I plan to edit this paragraph for understanding. I will also add a table to help readers more easily synthesize the information regarding the types of blood: hematochezia, melena, and BRBPR which can originate from outside of the anus(external hemorrhoids/anal fissure). I also plan to make mention of the complications that can occur due to bleeding, which will be a lead in to a section on anemia.

Causes section Rather than provided a list of causes, with no division as to the types of bleeding in the GI tract. I plan to divide the section into bleeds originating from the upper, lower and both portions of the GI tract, in order to help provide some understanding as to what each type of blood may look like in the stool. As a result, there will be a few introductory sentences for each of these sections, as well as the Causes section, in order to orient the reader to those causes.

Diagnosis section This section will be brief, as this page refers to blood in stool as a symptom, rather than as a diagnosis. It is important, however, to consider that the reader may be interested to learn what types of testing exist in order to pursue a diagnosis of the cause of bleeding. This is where the division of the Causes section become more useful. Different types of tests for diagnosis are used for different types of bleeding, usually as it pertains to upper v lower GI tract as the source.

Anemia This is an important complication of copious blood in the stool, and should be mentioned on this page for the sake of thoroughness.

Mimics A short list of substances that may mimic a blood in the stool, particularly things like PeptoBismol, as it mimics old blood in the stool, could also be useful to the reader.

Please let me know your thoughts on my plans for the addition of all this new information to my article. Thanks Sarahguess5 (talk) 20:00, 20 November 2017 (UTC)

Thanks for your suggestions to help improve the page! I have a few comments based on your above suggestions and also your edits to date.

• Try to include a WP:MEDRS compliant citation after every sentence you add to Wikipedia (except in the lead). Even if you use the same citation more than once in a paragraph, that is fine. Be sure to "re-use" your citation if it already exists in the article, rather than adding it again.
• Please see WP:MEDMOS. This resource has more information about the "style" we are aiming for in these articles. For example, you mentioned "introduction" above, I assume you mean the article Lead (WP:LEAD)? This section is very important as it is usually the first thing people read, and we appreciate that you are helping to update it. Please verify the appropriate place in the article to add your table in. You are welcome to add new sections if you have referenced content, as per WP:MEDMOS suggested headings for your article type.
• Feel free to post your proposed sentences on the talk page before you add them live to the article, especially if you are not certain if it is correct, or if it is a large amount of content.

Thanks again for your help with this article. Happy editing!JenOttawa (talk) 01:34, 2 December 2017 (UTC)

Thanks for the recommendations. I will be sure to check out these sources. I have added two sections thus far that are heavily cited and refer to multiple wiki pages as well. I am also going to put a proposed edit to the list of causes below:

 

Causes

Blood in the stool can come from many sources. The causes range from not harmful to very serious conditions. A common way to divide causes of bleeding is based on the source of bleeding. The GI tract can be divided into upper and lower, with some causes of bleeding affecting the entire tract.

Upper GI tract

The upper GI tract is defined as the organs involved in digestion above the ligament of Trietz and is comprised of the esophagus, stomach, and duodenum. Upper gastrointestinal bleeding is typically characterized by melena, however bright red blood can be seen with active, rapid bleeding.

·Esophageal varices

·Gastric cancer

Peptic ulcer disease - divided into either duodenal or gastric ulcers, most common common causes include:

·NSAID medication

H. pylori infection

·Chronic disease

·Lower GI tract

·Bleeding of the lower GI tract will typically appear as hematochezia and can vary in seriousness.

·Anal fissure

·Colorectal cancer

·Internal hemorrhoids

→Internal hemorrhoids are caused by _ and bleed, but typically do not cause pain

→External hemorrhoids by comparison are caused by _ and are less likely to bleed, but can cause significant pain

·Diverticulosis

·Meckel's diverticulum

·Polypectomy during a colonoscopy can lead to a small amount of bleeding seen in the stool after the procedure

·Ulcerative colitis

Entire GI tract

The list below characterizes sources of bleeding that can occur anywhere along the GI tract, or affect multiple organs.

·Angiodysplasia of the GI tract

·Arteriovenous malformation

·Crohns disease

·Constipation

·Enteritis - inflammation of the small intestine, which may be caused by various forms of as well as by other conditions:

·Food poisoning - the bacteria that is associated with bloody diarrhea is typically E. coli

·Campylobacter enteritis

·Shigellosis

·Salmonellosis (salmonella enteritis/samonella enterocolitis)

·Bacterial gastroenteritis

Campylobacter jejuni

·Clostridium dificile

·Escherichia coli enteritis - most common cause of travelers' diarrhea

·Salmonella enterica

·Shigella dysenteriae see also dysentery

·Staphylococcus aureus

·Radiation enteritis

i appreciate any thoughts on the list above Sarahguess5 (talk) 19:59, 2 December 2017 (UTC)

• Good work so far with your recent edits. I made a few changes to the article, including moving some headings around to meet WP:MEDMOS. Please do take a look here.
• Do you think that the section that you added as "Characteristics" can be changed to meet the manual style for signs or symptoms? See Wikipedia:Manual_of_Style/Medicine-related_articles#Signs_or_symptoms
• If you format your suggestions above exactly how you wish to put them into the article (with citations, wikilinks, and formatting in place), it would help us evaluate your list. If you are using the visual editor, you can prepare and save your suggestion in your sandbox (using the visual editor) and then copy them using the "source editing" option in your sandbox as talk pages do not have the visual editor option.
• Thanks again for all your work to improve the article! I look forward to seeing your next contributions.JenOttawa (talk) 03:57, 3 December 2017 (UTC)

Thanks for all of your recommendations. To put the article in terms of signs and symptoms, I think I could change a few things around.

1. Include the characterization section in the evaluation section. I would then use the sources: <> and <> in order to briefly describe how those tests I listed in evaluation relate to the type of bleeding.

2. The anemia section I had proposed previously could fit nicely into a treatment and management section

3. Further, the characterization I used to describe melena and hematochezia could be used under a heading of definition

Thank you for all your help

Here is the formatted list with sources. Sarahguess5 (talk) 15:21, 3 December 2017 (UTC)

References

Evaluation

The tests that are considered for evaluation of the passage of blood in the stool is based on characteristic of bleeding (color, quantity) and whether or not the person passing blood has a low blood pressure with elevated heart rate, as opposed to normal vital signs. These tests are combined to determine which of the causes below is the source of bleeding.

• Digital rectal exam (DRE) and fecal occult blood test (FOBT)
• Colonoscopy
• Anoscopy
• EGD
• Capsule endoscopy
• CT Scan

Melena is defined as dark, tarry stools, often black in color due to partial digestion of the RBCs

Hematochezia is defined as bright red blood seen in the toilet either inside of, or surrounding the stool

Hematochezia is typically presumed to come from the lower portion of the GI tract, and the initial steps of diagnosis include a DRE with FOBT, which if positive, will lead to a colonoscopy. If bleeding is large in volume, the evaluation may also include an EGD. If no source of active bleeding is found on these examinations, a capsule endoscopy may be performed, in order to more closely examine the small bowel, which cannot be seen with the other types of studies. With melena, a DRE with FOBT is often also performed, however the suspicion for a source from the upper GI tract is higher, leading first to the use of EGD with the other tests utilized if no source is identified. The anoscopy is another examination, which can be used as an adjunct to the colonoscopy, which exams the rectum and distal portion of the descending colon.

Color	Medical term	Frequency	Quantity	Types of bleeding considered
Bright red	Hematochezia	Occasional	Small	Hemorrhoids, inflammatory conditions, polyps
Bright red	Hematochezia	Continous	Large	Upper or lower GI tract source of bleeding as a result of numerous causes (see below), rapid bleeding
Dark red/black	Melena	Every stool	Mixed with stool	Upper GI tract source, peptobismol and iron use can mimic melena

Sorry, I am out of time to review all of this tonight. I will try to re-visit early in the week. One thing I did notice was that your above suggestions are the original content you inserted, not your content already edited by others (or maybe just me) on the actual article page. Hope this makes sense! If you have any questions, you can send me a message via my talk page or add a @JenOttawa: to your questions so I notice it quickly. Thanks again, great work so far! JenOttawa (talk) 02:41, 4 December 2017 (UTC)

@JenOttawa you would be correct that some of this is the content I originally inserted, however, I changed it on the talk page in an effort to make it better meet the standards for WikiMedicine articles. I reorganized some of the sections using the same information in hopes that these sections would better adhere to the guidelines, while still covering the same information. Sarahguess5 (talk) 16:51, 6 December 2017 (UTC)

Thanks for the note Sarahguess5. Thanks as well for re-organizing the article as per WP:MEDMOS. As long as the modifications/edits already made by WikiProject Medicine volunteers to your content (in the actual article) are maintained, just so we do not have to go through it all over again! JenOttawa (talk) 17:19, 6 December 2017 (UTC)

@JenOttawa I definitely understand. I will be sure to check through it again during my work today, to ensure that content is maintained. Thanks for the help! Sarahguess5 (talk) 17:22, 6 December 2017 (UTC)

Other features

Mucus may also be found in stool.

A texture described as tarry stool is generally associated with dark black stool seen in partially digested blood. This is generally associated with melena.

Patient Age

Age is an important indicator for the diagnostic workup that is considered for the presence of blood in stool, as a result of the diagnoses that tend to affect each age group.

Age	Group	Types of bleeding considered
<20 years	Pediatric	Inherited/autoimmune condition or structural
20-60 years	Middle aged	Inherited/autoimmune condition, vascular malformation
>60 years	Elderly	Vascular malformation, liver disease, cancer

Sarahguess5 (talk) 02:36, 4 December 2017 (UTC)Sarahguess5 (talk) 02:38, 4 December 2017 (UTC)

References

Differential diagnoses and pathophysiology

Blood in the stool can come from many sources. The causes range from not harmful to very serious conditions. A common way to divide causes of bleeding is based on the source of bleeding. The GI tract can be divided into upper and lower, with some causes of bleeding affecting the entire tract. Blood in the stool often appears different depending on its source, guiding the diagnostic approach of these conditions, however, depending on the rate of bleeding, it can appear different from the typical presentation of the source.

Upper GI tract

The upper GI tract is defined as the organs involved in digestion above the ligament of Trietz and is comprised of the esophagus, stomach, and duodenum. Upper gastrointestinal bleeding is typically characterized by melena, however bright red blood can be seen with active, rapid bleeding.

Lower GI tract

The transition from the upper to lower GI tract is considered to occur at the duodenal-jejunal junction, therefore small intestine is part of both the upper and lower GI tract. Other organs participate in digestion including the liver, gallbladder, and pancreas. Blood entering the upper GI tract travels further, therefore has more exposure to the GI system and can be partially digested into melena before leaving the system. Hematochezia generally occurs lower in the GI tract, and is much closer to its exit, although fast bleeds can occur in the upper system as well.

Bleeding of the lower GI tract will typically appear as hematochezia and can vary in degree of seriousness. Slow bleeding from the ascending portion of the colon can result in partial digestion of the blood and the appearance of melena in the stool.

Pathophysiology

The development of blood in stool results from a variety of conditions, which can be divided into major categories of disease process. These broad categories include cancerous processes or abnormal structure of bowel wall, inflammatory disease, colitis caused by infection or medications and vascular compromise.

Neoplasm

• Colorectal cancer
• Gastric cancer

Gut wall changes

Motility

The gut wall is important to the movement of waste products through the GI tract. When compromise occurs at varying points along the tract

• Constipation

Structural

This list of diagnoses include diseases in which the wall of the bowel is compromised by disease.

• Peptic ulcer disease - divided into either duodenal or gastric ulcers, most common common causes include:
  • NSAID medication
  • H. pylori infection
  • Chronic disease

• Diverticulosis
• Meckel's diverticulum

Inflammatory bowel

• Crohns disease
• Ulcerative colitis

Colitis

Enteritis - inflammation of the small intestine, which may be caused by various forms of as well as by other conditions:

Infectious

• Food poisoning - the bacteria that is associated with bloody diarrhea is typically E. coli
• Campylobacter enteritis
• Shigellosis
• Salmonellosis (salmonella enteritis/samonella enterocolitis)
• Bacterial gastroenteritis
  • Campylobacter jejuni
  • Clostridium dificile
  • Escherichia coli enteritis - most common cause of travelers' diarrhea
  • Salmonella enterica
  • Shigella dysenteriae see also dysentery
• Staphylococcus aureus

Drug-induced

• Radiation enteritis
• NSAID induced peptic ulcer (reference above) — Preceding unsigned comment added by Sarahguess5 (talk • contribs) 17:29, 6 December 2017 (UTC)

Vascular compromise

• Angiodysplasia of the GI tract
• Arteriovenous malformation
• Anal fissure
• Esophageal varices
• Hemorrhoids
  • Internal hemorrhoids are covered by a layer of mucosa and epithelium, making them more likely to bleed, but typically do not cause pain
  • External hemorrhoids are less likely to bleed, they are covered by a different type of epithelium(squamous) but can cause significant pain as a result of thrombosis of the blood vessels within them

• Polypectomy during a colonoscopy can lead to a small amount of bleeding seen in the stool after the procedure

Sarahguess5 (talk) 18:12, 3 December 2017 (UTC)

References

placement of citations

Hi @Sarahguess5: please put all citations after punctuation, no spaces. I have corrected it up to "inflammatory bowl", but more needs to be done. There is also, generally, not a need to place citations in the middle of sentences. We sometimes use them after a comma if you are making a list, but try not to do this in all sentences as it makes it harder to read. Good work so far on your suggestions, I am out of time right now to review this. Please finish going through the article and correct the placement of citations. Thanks again, JenOttawa (talk) 02:44, 9 December 2017 (UTC)

JenOttawa thanks for the recommendation. I went back through the article and fixed any misplaced citations.Sarahguess5 (talk) 20:50, 10 December 2017 (UTC)

Thanks very much Sarahguess5.Looking good so far. Thanks for improving this article! JenOttawa (talk) 20:56, 10 December 2017 (UTC)

Happy to help!! Thanks JenOttawaSarahguess5 (talk) 03:02, 14 December 2017 (UTC)

Wiki Article Peer Review

Wiki article peer review on blood in stool: The article is very clear and understandable. The lead paragraph is strong and gives me a clear understanding of what blood in the stool is and a brief description of the two main kinds of described blood in the stool (hematochezia and melena). There is, by nature of the topic, lots of medical jargon that had to be used, but there are embedded links when appropriate and terms are defined when appropriate.

Everything in the article is relevant to the topic. If there was previous excess information, it has now been removed, and every part of the article is essential for getting a full, clear picture of blood in the stool.

The pathophysiology and evaluation sections of the article are heavier with medical jargon. In my opinion, this is by necessity. However, it would be difficult for a nonmedical person to read and understand these sections without going to other Wikipedia pages for further definitions. The author did a great job of minimizing confusion by embedding many other wikipedia pages for further clarification, which I think is the best solution to problems understanding medical jargon in this article.

The article is neutral and balanced. There are no statements or words present that would bias the reader toward and particular position. The article is purely informational and provides appropriate references after factual statements. The references provided support the statements where they were cited. The information is summarized nicely from the sources in the Wiki article writer’s own words, and I can see no concern for plagiarism. The majority of the sources were published in the last 5 years but there are some references from 1990—however, the information from these references is concerning history and physical exam, which is information that has not changed and is still relevant to the topic currently.

Things to change or add: I think it could potentially be helpful to provide images of melena and hematochezia. While there are links to both of these words for further information, I think it could add value to this particular article. Also, I think the table in the evaluation section could be simplified a little to make it easier to read.

Great job! You’ve done really good work. Vway2209 (talk) 00:41, 11 December 2017 (UTC)

Vway2209 Thank you for the great recommendations. I was having a hard time deciding whether to add those photos, so your feedback is helpful. I will also work on that table. Sarahguess5 (talk) 20:16, 13 December 2017 (UTC)

So I have searched high and low for a publicly available image of melanic stool to add to this article with no success. I will continue to look and bring it up in a conversation with those who may be able to help more. Another thought is to include the image available for black blood in the upper GI article. Sarahguess5 (talk) 03:05, 14 December 2017 (UTC)