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)

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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
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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
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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

-

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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
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6
Q

Rectal Cancer

  • bright red or mixed in?
  • tenesmus?
  • Tx?
A
  • bright red
  • yes
  • anterior resection with pre-operative radiotherapy
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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

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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.

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