🩸 Lower GI Bleeding · Hematochezia · Meckel · Polyp · IBD · Fissure

Schwartz Clinical Handbook — Chapter 34 · Anal fissure · Juvenile polyp · Meckel diverticulum · IBD · C. diff · HSP · HUS

Select stool color (bright red, currant jelly), pain pattern, age, perianal findings, and associated symptoms → differentiate anal fissure, infectious colitis, Meckel diverticulum, juvenile polyp, intussusception, IBD, or HUS.
⚠️ Red flags: hemodynamic instability, massive bleeding, abdominal distension, toxic appearance → urgent resuscitation and surgery consultation.

📋 Step 1 — Bleeding pattern & associated findings
📌 Diagnostic impressions
📖 Schwartz Ch 34

Select stool color (bright red, dark red, currant jelly), age, pain (cramping, colicky, none), perianal exam, and systemic signs → differential includes anal fissure, juvenile polyp, Meckel diverticulum, intussusception, IBD, infectious colitis, HUS.

✔️ Bright red streaks + painful defecation → anal fissure.
✔️ Painless rectal bleeding + age 2‑8y → juvenile polyp.
✔️ Currant jelly + episodic pain → intussusception.
✔️ Bloody diarrhea + HUS triad → E. coli O157:H7.
📘 Schwartz pearls (Chapter 34)
• Meckel scan (Tc‑99m pertechnetate) for painless rectal bleeding (gastric mucosa).
• Colonoscopy for polyps or IBD.
• C. diff toxin after antibiotic exposure.
• HSP: palpable purpura, arthritis, abdominal pain.