General: PR Bleeding Flashcards
What causes PR bleeding?
Diverticular disease = symptomatic outpouching of bowel wall
Angiodysplasia = small vascular malformation of the gut
Haemorrhoids = swollen and inflamed veins
Malignancy = colorectal cancer
Stomach ulcer
Anal fissures
IBD
Ischemic colitis
Aorto-enteric fistula
What are the important clinical features of PR bleeding that need to be ascertained?
Nature of bleeding = duration, frequency, colour of the bleeding, relation to stool and defecation
Associated symptoms = including pain (whether it wakes them at night, is relieved or worsened by defaecation), haematemesis, mucus, previous episodes
FH = bowel cancer or IBD
How should PR bleeding be investigated?
Hx = other lower GI symptoms, weight loss, or relevant family history
Flexible sigmoidoscopy or colonoscopy = exclude left-colonic malignancy
PR
Bloods = FBC, U+Es, LFT, coag, group and save
Stool cultures = exclude infection
Angiogram = dentification of culprit bleeding vessels and also permits for therapeutic intervention
Haemodynamically unstable = oesophago-gastroduodenoscopy (OGD) +/- CT angiogram with embolisation
How should PR bleeding be managed?
A-E assessment = gaining 2 large bore cannulae, IV fluid, and blood products (if required)
95% of cases will settle spontaneously = bleeding stopped, normal Hb = discharge + investigate as outpatient
Unstable = resuscitation and urgent endoscopy and CT angiogram
What are the possible complications from PR bleeding?
Anaemia = dizziness, fatigue, weakness, headaches, SOB
Becoming haemodynamically unstable
Dehydration
What are haemorrhoids?
Raise in intra-abdo pressure = obstructs venous return = venous plexus engorges
Bulging mucosa is then dragged distally by hard stool
3, 7, 11 o’clock positions = correspond to the anal cushion positions
How are haemorrhoids classified?
First degree = piles never prolapse
Second degree = piles prolapse during defaecation and then return
Third degree = piles remain outside the anal margin unless replaced digitally
