Rectal Bleeding Flashcards
What causes Painful bleeding that occurs post defecation in small volumes, associated with constipation?
Anal fissure with bight red blood. Muco-epithelial defect usually in the midline posteriorly
What do anterior anal fissures indicate?
Underlying disease like IBD or STI
What causes bleeding on toilet paper and dripping, with no local pain?
Haemorrhoids with bright rectal bleeding.
What visualises internal haemorrhoids?
Proctoscopy may show internal haemorrhoids. Internal haemorrhoids are usually impalpabl
What causes rectal bleeding with altered bowel habit, malaise and history of anterior fissures?
Crohn’s disease, revealing fissures or fistula on examination
what is proctitis
Inflammation of rectum and anus
What causes bright red bleeding mixed with stool, PROCTITIS and diarrhoea and weight loss?
Ulcerative colitis
What causes bright red blood with obvious mucosal abnormality?
Rectal cancer, with altered bowel habit
What is the initial investigation for rectal bleeding?
digital rectal examination and procto-sigmoidoscopy as a minimal baseline.
What to determine in young patient with no concerning history features?
Sigmoidoscopy can be performed and assess for haemorrhoids
What is the best test for rectal bleeding + altered bowel habit
Colonoscopy
What causes pain that exaination cannot be performed?
Fissure
What is the management of anal fissure?
GTN ointment 0.2% or diltiazem cream applied topically is the usual first line treatment
-> botulinum second line
What is the management of haemorrhoids
Lifestyle advice, for small internal haemorrhoids can consider injection sclerotherapy or rubber band ligation. For external haemorrhoids consider haemorrhoidectomy
What is the management of rectal cancer?
Anterior resection or abdomino-perineal excision of the colon and rectum. Total mesorectal excision is now standard of care
Requires de functioning ileostomy
