PR BLEEDING Flashcards
causes of PR bleeding ?
local - heamorrhoids
anal fissures and fistulas
vascular - mesenteric ischemia
angiodysplasia
infective - gastroenteritis
such as campylobacter , shigella , ecoli , yersinia , salmonella
neoplastic - anal cancer , colorectal
inflammatory - diverticulitis , ulcerative colitis , chrons disease, c.diff
side effects of medications she has AF
what would you like to oknow from the history of PR bleed
onset
duration
volume and colour
particular time of day if this happens
any recent infection or travel or recent antibiotics
systemic signs - such as change in bowel habits , unintentional weight loss , abdominal pain
PMHX of anticoag or antiplatlet
any IBD or divertivulosis
social his- smoker or drinker
FAMILY HISTORY OF - CLOTTING DISORDER R COLORECTAL CANCER
other than bloods what is important to order in investigation
ECG
in PR bleed i would like ABG - to check for signs of hypoperfusion or acidosis - which can indicate ischemia
DIGITALRECTAL EXAMINTION - assess for POLYPS , haemorrhoids , fissures also allows me to assess the
ALSO ALLOWS THE NATURE AND VOLUME OF BLEEDING ASSESMENT
STOOL CULTURE
group and save
abdominal x ray - to r/o toxic megacolon or obstruction
The British Society of Gastroenterologists recommends an urgent CT angiogram for haemodynamically unstable patients once the patient has been successfully resuscitated and active bleeding is suspected.
if stable colonoscopy
ABG shows metabolic acidosis and high lactate management
this indicates mesenteric ischemia
I would start them on stat iv fluids
call my seniors such as registrar or consultant in charge -patinet might need urgent laprotomy / surgical managmnet
I would also involve CCOT if not responding to treatment
