Rectal Bleeding Flashcards
What are the differentials of anorectal bleeding?
Haemorrhoids Rectal tumour Anal tumour Anal fissure Anal fistula Solitary rectal ulcer Radiation proctitis Rectal varices Trauma
What are the differentials of colonic bleeding?
Diverticular disease Angiodysplasia Colitis (inflammatory, ischaemic, infective) Colonic tumour Iatrogenic Vasculitis
What are the differentials of ileo-jejunal bleeding?
Peptic ulceration (including Meckel's diverticulum) Angiodysplasia Arteriovenous malformation Crohn's disease Coeliac disease Aorto-enteric fistula Small bowel tumour
What are the differentials of upper GI?
Peptic ulcer Gastritis/duodenitis Varices Tumour Mallory-Weiss tear Osler-Weber-Rendu syndrome
What additional symptoms would you ask about in a patient with rectal bleeding?
Pain or prolapse? Anal fissure = pain during, Colitis = cramping, Lower anal cancer can present with pain
Tenesmus? - Mass or colitis
Changes to bowel habit?
Weight loss?
Symptoms of anaemia?
Rectal bleeding mixed with stool + pain?
Colitis
Rectal bleeding mixed with stool - pain?
Colonic tumour
Colitis
Blood streaked on stool + pain?
Anal tumour
Blood streaked on stool - pain?
Rectal tumour
Blood separate from stool + pain?
Colitis
Blood separate from stool - pain?
Haemorrhoids Diverticular disease Angiodysplasia Rapidly bleeding colonic/rectal tumour Colitis (+mucus)
Blood on toilet paper + pain?
Anal fissure
Blood on toilet paper - pain?
Haemorrhoids
Why is a detailed drug history important when investigating rectal bleeding?
Increased risk of bleeding
Increased risk of peptic ulcers (NSAIDs, steroids and bisphosphonates)
Increased risk of infectious colitis (Antibiotics and PPIs)
Decreased heart response to hypovolaemia
When is it possible to feel haemorrhoids on a DRE?
When they are either prolapsed or thrombosed
