Differential Diagnosis - Common presentations

Question 1

Lower Rectal Bleed

Answer 1

Anus

• Haemorrhoids (internal, external)
• anal fissure
• anal fistula

Rectum
Tumours -polyps (benign, malignant), adenocarinoma
-Proctitis

Colon

• Tumors – polyps, adenocarcinoma
• Diverticular disease
• Angiodysplasia – AV malformations
• IBD

Upper GI tract bleed (Melena)

Question 2

Dysphagia

Answer 2

Oesophageal wall 
Oesophageal carcinoma (Adenocarcinoma - barrets, squamous cell - smokers/drinkers) 
Peptic structure (chronic GORD)
Caustic stricture (strong acids)

Motility

• Achalasia (failure of pyloric sphincter relaxation)
• Oesophageal spasm
• nuerological (stroke, motor neuron disease)
• Scleroderma

External pressure on oesophagus

• lung cancer
• hilar lymphadenopathy
• paraoesophageal hernia