Rectal Bleeding Flashcards
What is another name for rectal bleeding?
Haematochezia
What are the differential diagnosis for rectal bleeding?
Commonly from lower GI (rectum or colon) - diverticular disease, ischaemia, infective colitis, haemorrhoids, malignancy, angiodysplasia, IBD, radiation proctitis
What is the Oakland score used for in the context of rectal bleeding?
Determine if outpatient management is feasible
What investigations should be done for rectal bleeds?
Routine bloods
G&S
Stool cultures - rule out infective cause
Amylase - pancreatitis
Urgent CT angiogram (before endoscopy therapy) - identify source of bleed and potential therapeutic intervention with embolisation
What further investigations can be done for rectal bleeds?
Stable bleeds - flexible sigmoidoscopy or colonoscopy
OGD is suspected upper GI bleed
Further to this if inconclusive - capsule endoscopy or MRI small bowel scans
What are the risk factors for adverse outcomes from acute rectal bleeding?
Haemodynamically instability
Ongoing haematochezia
Age >60
Serum creatinine >150umol/L
Significant co-morbities
Below what level is transfusion of packed red blood cells required for rectal bleeding?
Hb<70
Or Hb<80 if history of CVD
Anticoagulation should be reversed
What are the potential management options for rectal bleeding?
Most settle spontaneously - manage as out patient if stable and low risk
If unstable fluid resuscitation
Endoscopic haemostasis methods
Arterial embolisation
Rarely surgery
What is endoscopic homeostasis methods?
Injection (diluted adrenaline)
Contact and non-contact thermal devices (bipolar electrocoagulation or argon plasma coagulation)
Mechanical therapies (endoscopic clips and band ligation)
When would surgery be consider in rectal bleeds?
Ongoing bleed requiring continuous transfusions and endoscopic and radio graphic treatments have failed
