PR bleed

Question 1

What causes PR bleed?

Answer 1

Passage of fresh blood through the rectum caused by bleeding from the lower GI tract

Question 2

What causes fresh rectal bleeding?

Answer 2

Lesion in the rectum or colon

May be from an actively bleeding stomach ulcer

Question 3

A patient has a large rectal bleed and is haemodynamically unstable. What do you suspect?

Answer 3

Upper GI bleed until proven otherwise

Question 4

What is the most common cause of lower GI bleed? Other causes?

Answer 4

Diverticular disease
Haemorrhoids
Malignancy
Anal fissures
IBD

Question 5

What are diverticula? Where do they most commonly occur?

Answer 5

Outpouchings of the bowel wall that are composed of only mucosa. They most commonly occur int he descending and sigmoid colon.

Question 6

What are haemorrhoids?

Answer 6

Pathologically engorged vascular cushions in the anal canal that can present as a mass with pruiritis or fresh red rectal bleeding.

Question 7

What are clinical features to gain from history?

Answer 7

Duration, frequency, colour, relation to stool of bleeding
Associated symptoms: pain, haematemesis, mucus, previous episodes
Family history of bowel cancer or IBD

Question 8

What examination and investigation for rectal bleed?

Answer 8

PR examination for rectal masses/ anal fissures
Routine bloods, group and sace
Stool cultures to exclude infective causes
Flexible sigmoidoscopy for further assessment and to exclude left colonic malignancy
Full colonoscopy or angiogram if flexible sigmoidoscopy is inconclusive
OGD if haemodynamically unstable

Question 9

What is management for rectal bleed?

Answer 9

If large - resuscitation, IV fluids, blood products if requires
Most settle spontaneously