Blood in stool

Question 1

Key history in blood in stool

Answer 1

Melena vs. bright red blood
Amount, duration
Other symptoms (constitutional, abdominal or rectal pain, tenesmus, constipation/diarrhea)
Menstrual cycle
Trauma
Past episodes
Prior colonoscopy
Medications (especially blood thinners)
Hx of easy bleeding or atherosclerosis, valvular disease, renal disease, liver disease, alcoholism, AAA repair
FHx of colon cancer

Question 2

Key physical exam in blood in stool

Answer 2

Vital signs +/- orthostatics

Abdominal and rectal exams

Question 3

67 yo M with blood in stool, weight loss and constipation

+ FHx of colon cancer

Answer 3

Colorectal cancer
Anal fissure
Hemorrhoids

Rectal exam, CBC, AST/ALT/bilirubin/alkaline phosphatase, INR, CEA, colonoscopy, CT - abdomen/pelvis, barium enema

Question 4

33 yo F with rectal bleeding and diarrhea over last week

+ lower abdominal pain and tenesmus for months

Answer 4

Ulcerative colitis
Crohn’s disease
Proctitis

Rectal exam, CBC, PT/PTT, colonoscopy, CT - abdomen/pelvis

Question 5

58 yo M with bright red blood per rectum and chronic constipation
+ low-fiber diet

Answer 5

Diverticulosis
Anal fissure
Hemorrhoids

Rectal exam, CBC, type and cross, PT/PTT, electrolytes, colonoscopy, tagged RBC scan, CT - abdomen/pelvis