1. What is the clinical problem?

Bright red blood per rectum. Hematochezia.

2. Develop a differential diagnosis by listing diseases which may present with this problem, especially in an elderly person?

Generally indicates lower GI tract hemorrhage from the colon or distal ileum.

• Small volume Hematochezia

  • anorectal disease

  • colitis (ischemic)

  • polyps or neoplasm

• Large volume Hematochezia

  • diverticulosis

  • arteriovenous malformation

3. What is your diagnosis?

Arteriovenous malformation

4. Compare and contrast melena, hematochezia and occult blood in the stool.

Hematochezia: Bloody bowel movement

Melena: Black, sticky, tarry, malodorous stool

• Usually from upper GI bleed , above the colon

• Digestive enzymes act upon the blood to change the color and consistency

Occult blood: Bleeding may occur anywhere from the naso-pharynx to anus.