2020年10月23日星期五

hemorrhoids in children,Hematochezia in children (cause-manifestation-check-treatment)

    Blood in the stool discharged from the anus, whether the stool is bloody or all bloody, is bright red, dark red, or tarry, it is called blood in the stool. Blood in the stool often indicates bleeding in the lower gastrointestinal tract, especially bleeding from the colon and rectum. Hematemesis with hematemesis is a manifestation of upper gastrointestinal bleeding. The color of stool depends on the location of the bleeding, the amount of bleeding and the time spent in the intestine. Upper gastrointestinal bleeding is mostly melena. If the amount of bleeding is large and the discharge is fast, It can also be dark red or even bright red. Bleeding from the lower gastrointestinal tract is mostly bright red or dark red, and if it stays in the intestine for a long time, it can also turn into melena. Tar-like black stools indicate a bleeding volume of more than 60ml. People with blood in the stool may not have hematemesis, and people with hematemesis usually have melena. Hematochezia can also be part of the manifestation of systemic diseases, and sometimes "hematochezia" can be caused by swallowing blood from outside the digestive tract. Causes Common causes of blood in the stool: 1. Lower gastrointestinal diseases (1) Anal canal diseases Anal fissures and hemorrhoids. (2) Rectal diseases Anus and rectal injuries, rectal polyps, rectal tumors, etc. (3) Colon and small intestinal diseases: Bacterial dysentery, amoebic dysentery, localized enteritis, intussusception, tuberculosis, typhoid fever, distal ileal diverticulitis, melanoma-gastrointestinal polyposis, intestinal duplication malformations, small intestinal vessels Tumors, small bowel tumors, mesenteric artery embolism, etc. 2. Upper gastrointestinal diseases esophagus, stomach and duodenum, biliary tract diseases, etc. 3. Systemic and toxic diseases (1) Hemorrhage, coagulopathy, hematological diseases, neonatal hemorrhagic disease, severe infections and DIC. (2) Acute infectious diseases and parasitic diseases: Epidemic hemorrhagic fever, typhoid, paratyphoid and typhus, leptospirosis, hookworm disease, schistosomiasis, sepsis, etc. (3) Poisoning or drug toxicity, sepsis, bacterial food poisoning, toxic plant poisoning, drug toxicity, chemical poisoning, etc. (4) Hereditary hemorrhagic telangiectasia The above diseases cause intestinal inflammation and ulcers, intestinal blood circulation disorders, gastrointestinal mucosal damage, or increased capillary permeability, leading to blood in the stool. Clinical manifestations of children with blood in the stool should be inquired in detail about the medical history and comprehensive physical examination. Pay attention to the following points: 1. Pre-examination for blood in the stool Before determining the blood in the stool, carefully check whether it is bleeding in the oral cavity, nasopharynx, bronchi and lungs. Black stools caused by swallowing, blood samples or black stools caused by excluding certain drugs and foods. 2. According to the age of children, neonatal blood in the stool is mostly caused by swallowing blood from the mother's birth canal or ruptured nipple or suffering from neonatal spontaneous hemorrhage, hemorrhagic necrotizing enteritis, gastrointestinal malformations, etc. Hematochezia in infants and young children is more common in intussusception, Meckel's diverticulum, intestinal polyps, anal prolapse, anal fissure, etc. Preschool and school-age children with blood in the stool should consider esophageal varices, ulcer disease, intestinal polyps, anal fissure, allergic purpura, etc. 3. Blood volume and color in stool A small amount of blood in the stool and bright red, the blood is attached to the surface of the stool, most of which is bleeding from the rectum, sigmoid colon or descending colon. If the child does not cry or quarrel during the defecation, consider rectal polyps. If the child cries badly Consider anal fissure, which is also seen in intussusception. Large amounts of blood in the stool, dark red or black, mostly bleeding from the upper gastrointestinal tract or acute hemorrhagic necrotizing enteritis, enteric typhoid fever. Jam-like stool is a mixture of blood and mucus that looks like sticky and frozen stool. If a child is 6 to 18 months old, accompanied by paroxysmal crying and noise, intussusception should be considered. Bean soup-like stool: stools are bloody and smelly. When considering hemorrhagic necrotizing enteritis, children often have abdominal pain and obvious abdominal distension. 4. The relationship between blood in the stool and defecation Blood drips after the stool, and it is not mixed with the stool, which is more common in internal hemorrhoids and anal fissures, but also in rectal polyps and rectal cancer. Stools are pus-like blood or bloody stools with pus-like mucus. Pay attention to dysentery, schistosomiasis, intestinal tuberculosis, and chronic colitis. 5. Other accompanying symptoms of blood in the stool with severe abdominal pain or even shock should pay attention to mesenteric vessel obstruction, hemorrhagic necrotizing enteritis, intussusception; blood in the stool with abdominal mass should pay attention to intussusception, tumors, etc.; blood in the stool with more bleeding in other parts of the body It is found in blood system diseases, acute severe infections, vitamin C deficiency, etc.; symptoms of blood in the stool with fever and systemic poisoning are mostly acute infections. Unexplained blood in the stool must undergo anal examination and digital rectal examination to help find anal fissures, rectal polyps, hemorrhoids, intussusception, and cancer. 6. Common features of blood in the stool (1) Hemorrhoids Generally, anal bleeding caused by hemorrhoids is internal hemorrhoid bleeding, which occurs during or after defecation. The blood is bright red, does not mix with stool, and is accompanied by foreign bodies protruding outside the anus. (2) Anal fissure The biggest symptom of anal fissure hemorrhage is pain, the blood is bright red, there are drops of blood, and severe pain occurs after defecation. (3) The amount of bleeding from anal fistula is not a lot, the stool is pus and blood, and frequent defecation, the child will also have nausea, dizziness, and a lot of bleeding, iron deficiency anemia will appear in the patient, and shock will occur in severe cases.(4) Enteritis bleeding is intermittent, similar to anal fistula bleeding, the amount of bleeding is not a lot. (5) Intestinal polyps are painless, bloody and bright red, and do not mix with feces. They are often accompanied by mucus flowing out of the anus, sometimes with a feeling of prolapse. Inspection 1. Laboratory examination. Visually observe the color of the stool, blood volume, whether there is mucus and pus or blood, and whether the blood is mixed with the stool. Stool microscopic examination can find the pathological components of intestinal inflammation, parasite eggs and certain parasites (such as amoeba). There is no red blood cell in the blood under the microscope, so an occult blood test should be done. Peripheral blood hemoglobin and red blood cell counts help to understand the extent of blood loss. Examination of blood coagulation function. Stool culture, incubation of schistosomiasis trichomes, immunological examinations such as serum ring egg precipitation test and indirect hemagglutination test of freeze-dried red blood cells, Widal reaction and Wai Fei reaction. 2. Special examinations (1) Proctoscopy and sigmoidoscopy can directly understand the lesions, such as internal hemorrhoids, polyps, ulcers, tumors, etc., and the contents can be taken for microscopy and biopsy. (2) Fiber colonoscopy can observe deep colon lesions. (3) The gastrointestinal barium meal fluoroscopy, photos and barium enema examination are helpful for the diagnosis of gastrointestinal ulcers, diverticula, polyps, tumors, etc. (4) Selective celiac angiography and radionuclide scanning are helpful for the diagnosis of gastrointestinal bleeding of unknown cause. Treatment 1. Etiological treatment. Treating the cause of the disease can cure blood in the stool. Such as neonatal hemorrhagic disease, generally only vitamin K1 treatment has a significant effect. Intestinal infectious diseases, blood in the stool often disappears quickly after using effective drugs. Hematochezia caused by systemic infectious diseases should be treated on the basis of comprehensive therapy. 2. Symptomatic treatment (1) Generally, those who deal with active bleeding should absolutely rest in bed and use sedatives. Strictly observe and record the children's mind, pulse, blood pressure and urine output. Keep the airway unobstructed to prevent suffocation caused by hematemesis. (2) Blood transfusion should actively supplement blood volume for patients with heavy bleeding. For those who have immediate blood transfusion without conditions, dextran, 5% glucose normal saline or compound sodium chloride solution can be given first. (3) Hemostasis Choose hemostatic agents according to different bleeding properties, such as Anluoxue, Ethylphenidamine, 6-aminocaproic acid, and p-carboxybenzylamine. For upper gastrointestinal bleeding, 4~8mg of norepinephrine can be added to 150~250ml normal saline orally or instilled in a gastric tube to contract local mucosal blood vessels. Cimetidine and omeprazole have good hemostatic effects on acute gastric and duodenal mucosal lesions and ulcer bleeding. 3. Surgical treatment Most rectal polyps can be removed under colonoscopy. Multiple polyps in the colon and small intestine, long-term heavy blood in the stool, can be explored by laparotomy to remove the intestinal section where the polyps are concentrated to stop bleeding and prevent malignant transformation. Intussusception such as air or barium enema that cannot be reset or takes more than 48 hours should be treated surgically. Distal ileum diverticulum and intestinal duplication with hemorrhage can be treated with local bowel resection.

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