Rectal Bleed In Adults

Question 1

Common causes of rectal bleed

Answer 1

Benign anorectal disease: H, FIssure, fistula-in-ano

Diverticular D, IBD, colonic polyps, colorectal or anal camcer.

Question 2

Less common causes of rectal bleed

Answer 2

Infectious gastroenteritis
Coagulopathies
Angiodysplesia (arteriovenous malformation) 
Upper GI bleed
Radiation proctitis
Trauma(poss sexual abuse) 
STI
Endometriosis
Meckels diverticulum
GI invasion of non GIT
Solitary rectal ulcer
Iscaemic colitis
Rectal varices

Question 3

Presentation

What other there may be?

Answer 3

Asses amount of bleed:(3)
- occult bleeding- presenting w/ anaemia
Moderate bleeding- ps w/ fresh or dark blood rectal bleed or melaena in a haemodynamically stable pt.
Massive bleed- large amt dark or fresh usually.

There may be:
Shock w/ systolic BP 2 units
Bleeding >3days
Sign re-bleed within week.

Massive lower GI bleed requires hosp admission.

Question 4

Bright fresh blood coming from low down GiT

Answer 4

Anal fissures
Haemorrhoids
+ higher up tho prob

Question 5

Blood mixed within stool

Answer 5

Originating from higher up

Question 6

Severity measures

Answer 6

Unexplained wt loss
Change in bowel habits- both frequency and consistency
Tenesmus- fissures
Anal sx- sorenes or pain- fissures, itchinh with piles
PMHx !! + trauma
Meds- warfarin or aspirin??

Question 7

Stool examination

Answer 7

Blood mixed with stool: blood is darker and usually indicated a lesion on Left side of colon or even transverse- carcinoma or IBD.
Shiny p black - recognised by pt as blood (melaena) - admit- upperGIt endoscopy- immediately or fastbtract service.
Use rockall score

Bright red- lesion in rectum or anus- H or F. Esp id assc anal sx- anal pain or pruritus ani. But could be proctitis or anal carcinoma as well.
‼️‼️ NEED FOR RECTAL EXAMINATION-> mass??‼️

Proctoscopy- identifies anorectal causes, not substitute for sigmoidoscopy.

Question 8

Invx

Answer 8

FBC- + G+s if vleeding profound.
Ferritin and iron studies if Fe anaemia suspected.
Clotting studies maybe
LFTs if liver disease suspected- coagulopathies
Faecal calprotectin- younger pts screen for IBD- high PPV

Further
Flex sigm- ⭐️ for younger pts - where concern other than haem or if tx to haem not work ❌

Colonoscopy- fhx or suspicion of cancer- allows tissue biopsy and removal - virtual colonoscopy also approved.

Virtual colonoscopy- CT colangiography- ct to examine orepared colon, distendted also.

Barium enema no more for rectal bleed investigation. Poor.

Question 9

Rectal bleeding

Answer 9

Common sx
Majority- benign causes: Anal fissures -Haemorrhoids common
Type+amount+age imp
In kids less common and usually very serious pathology- meckels, volvulus, …
Exclude colorectal cancer

50s cancer