CASE 37 - Bloody Stool

Question 1

My father had colon cancer. Could I have it too?

Answer 1

It is a possibility.

Tell me more about the symptoms you’re having that concern you with regard to cancer.

Question 2

Specific Qs:

Answer 2

1. Description (blood before, during or after defecation).
2. Bright red or dark blood.
3. Pain during defecation.
4. Urgency.
5. Tenesmus (ineffectual spasms of the rectum accompanied by the desire to empty the bowel).
6. Mucus in stool.
7. Recent abx use.

Question 3

PEx:

Answer 3

1. CV ==> A.
2. Chest ==> A.
3. Abdo ==> A + P + P.

Question 4

DDx:

Answer 4

1. CRC.
2. Hemorrhoids.
3. C.difficile colitis.
4. Diverticulosis.
5. Angiodysplasia.
6. Ulcerative colitis.

Question 5

Workup:

Answer 5

1. Rectal exam, stool for occult blood.
2. Colonoscopy.
3. Stool for C.difficile PCR.
4. Fecal leukocytes.
5. CBC.
6. Anoscopy.
7. Flexible proctosigmoidoscopy.
8. CT-abdo/pelvis.
9. INR/PT/PTT.