Rectal Bleeding (1*) Flashcards
Why is it important to look at how the PR bleed presents?
It gives a good indication of where the source of it is
What will occur if there’s bleeding in the Upper gut?
How will it present if the bleeding is from the Colon?
→ What are some causes of this?
How will it present if it the bleeding is from the Anus?
→ What are the causes of this?
→ How would you differentiate between the 2 causes in a hx?
➊ The blood will have a long transit time before reaching the anus, therefore coming out very black in colour and mixed in with the stool = Melaena
➋ Blood will be mixed in with stool
→ UC, Diverticulitis, Colorectal ca., Polyps, Infection (Dysentery)
➌ Bright red blood that coats the stool, and is seen on the tissue after wiping or dripping into the toilet
→ Haemorrhoids, Anal fissure
→ • Haemorrhoids can cause some pain for a bit after defecation
• Anal fissures are extremely painful and last 1-2 hrs after defecation
Haemorrhoids:
How are they graded and managed?
What’s a complication here?
→ How does this present?
→ How is it managed?
➊ * Grade 1 - No prolapse (i.e. internal) - Conservative management, including potential use of topical steroids to alleviate pruritus
* Grade 2 - Prolapse on straining, which spontaneously reduces - Rubber band ligation (preferred), sclerotherapy, or infrared photocoagulation
* Grade 3 - Prolapse on straining and requires manual reduction - Rubber band ligation is the treatment of choice
* Grade 4 - Prolapse on straining, and can’t be manually reduced, External haemorrhoids, or Low-grade haemorrhoids failing to respond to therapy - Surgical haemorrhoidectomy
N.B. All patients are given lifestyle and dietary advice, such as adequate fluids and a high-fibre diet to avoid constipation.
➋ Thrombosed haemorrhoids
→ Painful, purple protrusions
→ Conservative measures such as ice packs, laxatives, and lidocaine gels are 1st-line treatments. If these measures fail, surgical haemorrhoidectomy may be required.
