Rectal Bleeding Flashcards
1
Q
where is the site of bleeding if:
- bright red?
- dark red?
- malaena?
A
bright red = rectal anal canal origin
dark red = lower GI
malaena = gastro-duodenal source (upper GI)
2
Q
Fissure In Ano
- what type of rectal bleed?
- what is it?
- what % are posterior?
- if it’s anterior - due to what?
- Tx? 1st line and 2nd line
A
- bright red rectal bleed
- painful tear due to hard faeces, painful bleeding post defecation
- 90%
- underlying disease
- 1st line: GTN 0.2% cream or diltiazem
2nd line: botulinum toxin
3
Q
Haemorrhoids
- type of rectal bleed?
- bleeding on paper or in pan?
- due to?
- are internal haemorrhoids palpable?
- Tx: conservative? internal haemorrhoids? external haemorrhoids?
A
- bright red
- potentially both but not mixed in with stool
- constipation and prolonged straining
- no
- conservative: fluid^^, fibre^^
- internal: rubber band ligation
- external: haemorrhoidectomy
4
Q
Crohn’s Disease
- bright red blood or mixed in with stools?
- will have a hx of which type of fissures?
- perianal inspection will show?
A
- both
- anterior fissures
- fissures and fistulae
-
5
Q
UC
- bright red or mixed in with stool?
- most marked finding of UC with this presentation?
- is there perianal disease like with crohn’s?
A
- mixed in with stool
- proctitis
- no
6
Q
Rectal Cancer
- bright red or mixed in?
- tenesmus?
- Tx?
A
- bright red
- yes
- anterior resection with pre-operative radiotherapy
7
Q
all patients with rectal bleeding require as baseline? (2things)
if presenting with altered bowel habit/suspicion of IBD then what is better?
A
digital rectal examination
procto-sigmoidoscopy
colonoscopy
8
Q
o In young patients with external visible fissure and a compatible history - would you do an internal examination?
A
No - medical treatment is suitable and defer internal examination but if fails to heal then do internal exam.