70. Rectal bleeding

Question 1

Colorectal Ca.

Answer 1

-

Question 2

Colorectal Ca: management.

• test used to monitor post-operatively

Answer 2

-

CEA

Question 3

Massive PR bleed.

a) Worrying features
b) Initial assessment

Answer 3

a) Continuous bright red blood, haemodynamic instability (SBP < 90, shock, collapse), severe anaemia (< 7) or large drop in Hb/haematocrit

b) - Airway (+/- NG tube)
- Breathing: oxygen, SpO2, ?ABG, auscultate chest)
- Circulation: 2x large bore cannulae (FBC, haematinics, UEs, clotting, group/save, cross-match 2 units, lactate, glucose), IV fluid resuscitation (500 ml NaCl 0.9% over < 15 mins, up to 2L before escalating), ECG
- Disability: GCS, pupils, glucose
- Exposure: melaena/frank blood, abdominal mass/bleed, stigmata of liver disease

Question 4

Investigating rectal bleeding.

Answer 4

• Bloods: FBC, clotting, UEs, LFTs, Group/save and cross-match, glucose, lactate
• Stool sample: calprotectin, culture (?c diff toxin)
• UGI endoscopy/ colonoscopy (flexi sigmoidoscopy if < 50 years old)

2 week wait:
- age 50+ with unexplained rectal bleeding

Question 5

Causes of rectal bleeding.

a) Benign
b) More severe

Answer 5

a) Haemorrhoids, anal fissure, diverticular dx, polyps
b) IBD, bacterial gastroenteritis/colitis, diverticulitis, cancer (UGI, LGI), UGIB (melaena), ischaemic colitis (pain out of proportion with clinical picture), rectal varices, coagulopathy