What is the disease of children with bloody stools without pain

The occurrence of digestive diseases can be discovered through the shape and color of the stool, especially for children's stool. Parents should pay attention to it. When constipation occurs, children should eat more vegetables and fruits and drink more water. If the constipation is severe, medication should be used. This problem should not be underestimated. The condition of the stool can reflect the health of the stomach and intestines. Especially when there is blood in the stool, you should seek medical attention in time. But what disease does it cause children to have blood in the stool without pain?

If there is blood in the stool discharged from the anus, whether it is bloody or entirely bloody, and the color is bright red, dark red or tarry, it is called hematochezia. Excessive blood in the stool indicates bleeding in the lower gastrointestinal tract, especially in the colon and rectum. Blood in the stool accompanied by vomiting blood is a manifestation of upper gastrointestinal bleeding. The color of the stool depends on the location of the bleeding, the amount of bleeding and the time it stays in the intestine. Upper gastrointestinal bleeding is mostly black stool. If the amount of bleeding is large and discharged quickly, it may also be dark red or even bright red. Lower gastrointestinal bleeding is mostly bright red or dark red. If it stays in the intestines for a long time, it may turn into black stools. Tarry black stools indicate a bleeding volume of more than 60 ml. People with blood in the stool may not vomit blood, but those with vomiting blood often have black stools. Blood in the stool can also be part of a systemic disease. Sometimes swallowing blood from outside the digestive tract can also cause "blood in the stool."

Causes

Common causes of blood in stool:

1. Lower gastrointestinal tract diseases

(1) Anal canal diseases: anal fissures and hemorrhoids.

(2) Rectal diseases: Anal and rectal injuries, rectal polyps, rectal tumors, etc.

(3) Colon and small intestinal diseases: bacterial dysentery, amebic dysentery, localized enteritis, intussusception, intestinal tuberculosis, enterotyphoid fever, distal ileal diverticulitis, melanoma-gastrointestinal polyposis, intestinal duplication, small intestinal hemangioma, small intestinal tumor, mesenteric artery embolism, etc.

2. Upper digestive tract diseases: esophageal, stomach, duodenum, bile duct diseases, etc.

3. Systemic and toxic diseases

(1) Bleeding, coagulation disorders, blood diseases, neonatal hemorrhagic disease, severe infection and DIC, etc.

(2) Acute infectious and parasitic diseases: hemorrhagic fever, typhoid, paratyphoid and typhus, leptospirosis, hookworm disease, schistosomiasis, sepsis, etc.

(3) Poisoning or drug toxicity: sepsis, bacterial food poisoning, poisonous 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 bloody stools.

Clinical manifestations

When children have blood in their stool, you should ask about their medical history in detail and conduct a comprehensive physical examination, paying attention to the following points:

1. Check before blood in stool

Before confirming that it is blood in the stool, you should carefully check whether it is black stool caused by bleeding from the mouth, nasopharynx, bronchi and lungs after swallowing, and rule out blood samples or black stools caused by certain drugs or foods.

2. According to the age of the child

Most newborns have blood in their stools because they swallow blood from the mother's birth canal or ruptured nipples, or because they suffer from neonatal spontaneous hemorrhage, hemorrhagic necrotizing enteritis, gastrointestinal malformations, etc. Blood in the stool of infants and young children is often seen in intussusception, Meckel's diverticulum, intestinal polyps, rectal prolapse, anal fissure, etc. If children of preschool age or school age have blood in their stool, esophageal varices, ulcer disease, intestinal polyps, anal fissure, Henoch-Schönlein purpura, etc. should be considered.

3. Amount and color of blood in stool

A small amount of blood in the stool is bright red and attached to the surface of the stool. It is mostly bleeding from rectal, sigmoid colon or descending colon diseases. If the child does not cry or make noise when defecating, rectal polyps should be considered. If the child cries and makes noise a lot, anal fissure should be considered, which is also seen in intussusception. Large amounts of blood in the stool, which is dark red or black, are mostly caused by bleeding in the upper gastrointestinal tract or acute hemorrhagic necrotizing enteritis, typhoid fever, etc. Jam-like stool is a mixture of blood and mucus that is like sticky jelly. If the child is 6 to 18 months old and is accompanied by paroxysmal crying and noise, intussusception should be considered. Bean soup-like stool: The stool is bloody and fishy, ​​and it is considered to be hemorrhagic necrotizing enteritis. Children often have obvious abdominal pain and bloating.

4. The relationship between blood in stool and defecation

Blood dripping after defecation and not mixed with the stool is often seen in internal hemorrhoids, anal fissures, and also in rectal polyps, rectal cancer, etc. If the stool is bloody and pus-like or bloody stool is mixed with pus-like mucus, you should pay attention to dysentery, schistosomiasis, intestinal tuberculosis, chronic colitis, etc.

5. Other associated symptoms

Patients with bloody stools accompanied by severe abdominal pain or even shock should pay attention to mesenteric vascular obstruction, hemorrhagic necrotizing enteritis, and intussusception; patients with bloody stools accompanied by abdominal masses should pay attention to intussusception, tumors, etc.; patients with bloody stools accompanied by bleeding in other parts of the body are often seen in blood system diseases, acute severe infections, vitamin C deficiency, etc.; patients with bloody stools accompanied by fever and systemic poisoning symptoms are mostly due to acute infections. Unexplained blood in the stool must be followed by anal and rectal examinations, which can help detect anal fissures, rectal polyps, hemorrhoids, intussusception, and cancer.

6. Characteristics of common bloody stool diseases

(1) Hemorrhoids Anal bleeding caused by hemorrhoids is usually internal hemorrhoid bleeding, which occurs during or after defecation. The blood is bright red and does not mix with feces. It may also be accompanied by foreign objects protruding from the anus.

(2) Anal fissure The biggest symptom of anal fissure bleeding is pain. The blood is bright red and drips like blood. Severe pain occurs after defecation.

(3) The amount of bleeding from anal fistula is not large, the stool is bloody and pus, and the bowel movements are frequent. The child may also experience nausea and dizziness. When the amount of bleeding is large, the patient will develop iron deficiency anemia, and in severe cases, shock may occur.

(4) Bleeding from enteritis is intermittent, somewhat similar to bleeding from anal fistula, and the amount of bleeding is not large.

(5) Intestinal polyps are painless and bright red in color. They do not mix with feces and are often accompanied by mucus flowing out of the anus, and there is occasionally a feeling of prolapse.

examine

1. Laboratory examination

Observe with the naked eye the color of the stool, the amount of blood, whether it contains mucus and pus, and whether the blood is mixed with the stool. Stool microscopy can reveal pathological components of intestinal inflammation, parasite eggs and certain parasites (such as amoebas). If there are no red blood cells under microscopic examination of the blood, a test for occult blood should be done.

Peripheral blood hemoglobin and red blood cell count help to understand the extent of blood loss. Coagulation function test. Stool culture, schistosome miracidium hatching, immunological examinations such as serum ring ova precipitation test and freeze-dried red blood cell indirect hemagglutination test, Widal reaction and Weil-Felix reaction.

2. Special inspection

(1) Proctoscopy and sigmoidoscopy can directly understand lesions, such as internal hemorrhoids, polyps, ulcers, tumors, etc., and can also take the contents for microscopic examination and biopsy.

(2) Fiberoptic colonoscopy can observe deep colon lesions.

(3) Gastrointestinal barium meal fluoroscopy, photography and barium enema examinations are helpful in the diagnosis of gastrointestinal ulcers, diverticula, polyps, tumors, etc.

(4) Selective abdominal artery angiography and radionuclide scanning are helpful in the diagnosis of unexplained gastrointestinal bleeding.

diagnosis

The diagnosis can usually be made based on medical history, physical examination and necessary auxiliary examinations.

treat

1. Treatment of the cause

Treating the cause can usually cure blood in the stool. For example, neonatal hemorrhagic disease can be effectively treated with vitamin K1 alone. Blood in the stool often disappears quickly after using effective medications for intestinal infectious diseases. Bloody stools caused by systemic infectious diseases should be treated on the basis of comprehensive therapy.

2. Symptomatic treatment

(1) Generally, patients with active bleeding should rest in bed and take sedatives. Closely observe and record the child's consciousness, pulse, blood pressure and urine volume. Keep the airway open to prevent suffocation caused by vomiting blood.

(2) Blood transfusion should be used to actively replenish blood volume for patients with heavy bleeding. If blood transfusion is unavailable immediately, dextran, 5% glucose saline, or compound sodium chloride solution can be transfused first.

(3) Hemostasis: Select hemostatic agents according to the nature of bleeding, such as anloxin, phensulfonamide, 6-aminocaproic acid, and p-carboxybenzylamine. For upper gastrointestinal bleeding, 4-8 mg of norepinephrine can be added to 150-250 ml of normal saline and taken orally in divided doses or dripped into a gastric tube to have a contraction effect on local mucosal blood vessels. Cimetidine and omeprazole have good hemostatic effects on acute mucosal lesions and ulcer bleeding in the stomach and duodenum.

3. Surgical treatment

Most rectal polyps can be removed during colonoscopy. In case of multiple polyps in the colon and small intestine and prolonged heavy bloody stools, laparotomy can be performed to remove the intestinal segments where the polyps are more concentrated in order to stop the bleeding and prevent malignant transformation. Intussusception should be treated surgically if it cannot be reduced with air or barium enema or persists for more than 48 hours. Distal ileal diverticula and intestinal duplication with bleeding may be treated with local intestinal resection.

Prognosis

Depends on the primary disease.

prevention

Once blood in the stool is discovered, timely diagnosis and treatment should be sought to avoid delaying the disease. Additional suggestions:

1. Let children develop the habit of regular bowel movements, and it is best if the stool is in a thin, mushy state.

2. Reduce postures that increase abdominal pressure, such as squatting and holding your breath. Avoid sitting, standing, walking for long periods of time and overwork.

3. Avoid spicy, greasy, rough, and residue-rich foods.