21. Rectal Bleeding Flashcards
What 4 categories can you classify the causes of rectal bleeding into?
Anorectal
Colonic
Ileo Jejunal
Upper GI
What are 7 anorectal causes of rectal bleeding?
Haemorrhoids Rectal/ anal tumour Anal fissure/ fistula Rectal ulcer Radiation proctitis Rectal varices Trauma
What are 6 colonic causes of rectal bleeding?
Diverticular disease Angiodysplasia Colitis Colonic tumour Iatrogenic: biopsy, anastamotic leak Vasculitis
What are 7 ileo jejunal causes of rectal bleeding?
(these are less common) Peptic ulcer Angiodysplasia AV malformation Crohn's disease Coeliac Aort-enteric fistula Small bowel tumours
What are 8 upper GI causes of rectal bleeding?
Peptic ulcer Gastritis Varices Tumours MW tear Osler Weber Rendu syndrome Aorto enteric fistula Dieulafoy lesion
What will you ask about in the presenting complain of someone with diarrhoea?
Amount Duration + frequency Colour of blood Relationship of blood with stool Pain or prolapse on opening the bowels Tenesmus Changes in bowel habit Weight loss Anaemia symptoms
What does blood mixed with the stool suggest?
Lesion proximal to sigmoid colon
What does blood streaked on stool suggest?
Source is sigmoid or anorectal
What does blood separate from the stool suggest?
Haemorrhoids If blood on its own- diverticular disease Angiodysplasia IBD Cancer
What does blood on the toilet paper suggest?
Minor bleeding from anal canal- haemorrhoids or anal fissure
Which causes of rectal bleeding are painful?
Colitis (abdo pain)
Anal tumour/ fissure
What should you ask in the PMHx of someone with diarrhoea?
Previous rectal bleeding UC Bowel trauma Bleeding tendency Aortic surgery Radiotherapy to rectum
What imaging should be done in someone with a rectal bleed?
Proctoscopy +/- endocopy unless it is a very painful lesion (anal fissure)
Which drugs increase the risk of bleeding?
Anticoagulants
Antiplatelets
NSAIDs
Which drugs increase the risk of peptic ulcers?
NSAIDs
Steroids
Bisphosphonates
