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? .

1. A

   Hematemesis

2. B

   Occult bleeding

3. C

   Hematochezia

4. D

   Melena

Appeared in: NORCET 9 Mains - 2025

Explanation

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• Hematochezia is the correct medical term for the passage of fresh, bright red blood through the anus, typically in or with stools.
• This type of bleeding indicates a source in the lower gastrointestinal (GI) tract, such as the colon, rectum, or anus.
• The patient's symptoms of bright red blood during defecation and the diagnosis of an anal fissure (a tear in the lining of the lower rectum) are classic signs of hematochezia.

Why Other Options Were Wrong

• Option A: Hematemesis is the vomiting of blood, indicating an upper GI bleed, not rectal bleeding.
• Option B: Occult bleeding is microscopic and not visible to the naked eye. The patient's bleeding is described as visible 'fresh bright red blood'.
• Option D: Melena refers to black, tarry stools caused by digested blood from an upper GI source. The patient's blood is fresh and red, indicating a lower GI source.

Related Visual

• Visual 1: Infographic: A chart comparing the appearance, source, and terminology (Hematochezia, Melena, Hematemesis, Occult Blood) of different types of gastrointestinal bleeding.

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 description and documentation of stool and any associated bleeding are fundamental nursing responsibilities. The color, amount, and consistency of blood can help the healthcare team quickly narrow down the potential cause and location of bleeding.
• An anal fissure, as noted in this patient, is a common cause of hematochezia. Nursing care involves pain management, promoting soft stools through diet and hydration, and teaching about sitz baths to promote healing.
• What if? If the patient's stool was described as black and tarry instead of bright red, the correct term would be Melena, and the medical team would investigate an upper GI source of bleeding instead of a lower GI one.

How to Approach the Question

• First, analyze the key clinical details in the question: 'fresh bright red blood', 'per rectum', and 'anal fissure'.
• Recognize that 'fresh bright red blood' points to a bleeding source that is close to the exit (anus), as the blood has not had time to be digested or change color.
• An 'anal fissure' is a known lower GI condition.
• Evaluate the options based on their definitions: Hematemesis (vomiting blood), Occult (hidden blood), Hematochezia (fresh rectal blood), and Melena (digested, black blood).
• Match the patient's symptoms to the correct definition. The description of fresh, red rectal bleeding perfectly matches the definition of Hematochezia.

Concept Tested & Keywords

• Concept Tested: Terminology for Gastrointestinal Bleeding
• Stem keywords: fresh bright red blood, per rectum, defecation, anal fissure
• Lead-in keywords: What is this type of bleeding called?
• Clinical cues: The color and route of bleeding (bright red, per rectum) are the key clues to identify the correct medical term.

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