A patient presents with fresh bright red blood per rectum during defecation. On examination, an anal fissure is noted. What is this type of bleeding called? .

Appeared in: NORCET 9 Mains - 2025

Explanation

Hematochezia is the medical term for the passage of fresh, bright red blood through the anus, usually in or with stools.
This type of bleeding indicates that the source is in the lower gastrointestinal (GI) tract, such as the colon, rectum, or anus.
The blood is red because it has not been exposed to stomach acid or digestive enzymes, meaning it has not been altered.
An anal fissure, which is a tear in the lining of the lower rectum, is a common cause of hematochezia.

Option A: Hematemesis is the vomiting of blood, not its passage through the rectum. The source is typically the upper GI tract.
Option B: Occult bleeding is, by definition, not visible to the naked eye. The patient in the scenario has visible 'fresh bright red blood'.
Option D: Melena refers to black, tarry, foul-smelling stools. This occurs when blood from an upper GI source is digested.

Clinical Relevance

Nursing practice connection: Use the key finding related to Terminology for Gastrointestinal Bleeding to guide bedside assessment, documentation, and the next nursing action.
Accurate assessment and documentation of stool characteristics are fundamental nursing responsibilities. Describing bleeding as 'hematochezia' versus 'melena' communicates critical information about the likely location of the bleed to the healthcare team.
For any patient reporting rectal bleeding, a key nursing intervention is to assess for signs of hemodynamic instability (e.g., hypotension, tachycardia, dizziness), which could indicate significant blood loss.
Patient education is vital. A nurse should instruct the patient to report any changes in bleeding, such as increased amount, frequency, or associated symptoms like pain or lightheadedness.

How to Approach the Question

First, analyze the key clinical details in the question stem: 'fresh bright red blood', 'per rectum', and 'anal fissure'.
Recognize that 'fresh bright red blood' points to a bleeding source close to the exit (anus), meaning the blood has not had time to be digested or altered.
The location 'per rectum' and the finding 'anal fissure' confirm a lower gastrointestinal source.
Evaluate the options based on their definitions: Hematemesis (vomiting blood), Occult (hidden blood), Hematochezia (fresh rectal blood), and Melena (dark, tarry stool).
Match the clinical presentation to the correct medical term. The description perfectly matches the definition of Hematochezia.

Concept Tested & Keywords

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E6 Medicine Macleod Clinical Examination 15e p. 120-122

E6 Medicine Harrison 22e Part 2 p. 488-490

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