Symptom Finder - Bloody Discharge
Bloody Discharge
Any body orifice may be the site of a bloody discharge. It usually is the cause of great alarm, as it should be in most cases. That is because a
bloody discharge often signifies malignancy. In most cases, a bloody discharge should be considered malignant until proven otherwise.
What basic science should be used to develop the differential diagnosis of a bloody discharge? The answer is anatomy, of course. For example, a
56-year-old woman complains of hematuria for several hours. The clinician knows the site of bleeding may be anywhere along the urinary
tract. Starting from the bottom up, he or she can visualize the urethra, bladder, ureters, and kidneys. By simply applying one’s knowledge of what is common, it is possible to develop a useful list of diagnoses as follows:
1. Urethra: urethritis, stone
2. Bladder: cystitis, stone, neoplasm
3. Ureter: stone
4. Kidney: stone, glomerulonephritis, neoplasm, polycystic kidney
The astute clinician will want a more exacting and extensive list of diagnostic possibilities. To obtain this, he or she can proceed to the second
step: Recalling the etiologic possibilities by using a mnemonic such as VANISH as follows:
V—Vascular suggests embolism, thrombosis, or subacute bacterial endocarditis.
A—Anomaly suggests polycystic kidney, double ureter, horseshoe
kidney, hereditary nephritis, and medullary sponge kidney.
N—Neoplasm suggests hypernephroma, Wilms tumor, or carcinoma of the bladder or prostate.
I—Inflammation suggests cystitis, pyelonephritis, glomerulonephritis, or tuberculosis.
S—Stones can be found in the kidney, ureter, bladder, or urethra and are a common cause of hematuria.
H—Hemorrhage should bring to mind trauma anywhere along the urinary tract as well as hematologic disorders such as Henoch–
Schönlein purpura, disseminated intravascular coagulation (DIC), and hypoprothrombinemia.
Here again, one can combine steps one and two to make a very useful table of the diagnostic possibilities. Now having a list of
possible causes of the patient’s symptoms makes the interview and workup more meaningful.
Any body orifice may be the site of a bloody discharge. It usually is the cause of great alarm, as it should be in most cases. That is because a
bloody discharge often signifies malignancy. In most cases, a bloody discharge should be considered malignant until proven otherwise.
What basic science should be used to develop the differential diagnosis of a bloody discharge? The answer is anatomy, of course. For example, a
56-year-old woman complains of hematuria for several hours. The clinician knows the site of bleeding may be anywhere along the urinary
tract. Starting from the bottom up, he or she can visualize the urethra, bladder, ureters, and kidneys. By simply applying one’s knowledge of what is common, it is possible to develop a useful list of diagnoses as follows:
1. Urethra: urethritis, stone
2. Bladder: cystitis, stone, neoplasm
3. Ureter: stone
4. Kidney: stone, glomerulonephritis, neoplasm, polycystic kidney
The astute clinician will want a more exacting and extensive list of diagnostic possibilities. To obtain this, he or she can proceed to the second
step: Recalling the etiologic possibilities by using a mnemonic such as VANISH as follows:
V—Vascular suggests embolism, thrombosis, or subacute bacterial endocarditis.
A—Anomaly suggests polycystic kidney, double ureter, horseshoe
kidney, hereditary nephritis, and medullary sponge kidney.
N—Neoplasm suggests hypernephroma, Wilms tumor, or carcinoma of the bladder or prostate.
I—Inflammation suggests cystitis, pyelonephritis, glomerulonephritis, or tuberculosis.
S—Stones can be found in the kidney, ureter, bladder, or urethra and are a common cause of hematuria.
H—Hemorrhage should bring to mind trauma anywhere along the urinary tract as well as hematologic disorders such as Henoch–
Schönlein purpura, disseminated intravascular coagulation (DIC), and hypoprothrombinemia.
Here again, one can combine steps one and two to make a very useful table of the diagnostic possibilities. Now having a list of
possible causes of the patient’s symptoms makes the interview and workup more meaningful.