Rectal Bleeding Flashcards
Rectal bleeding
Blood- fresh, altered, melaena
On tissue or mixed in stool
When does it occur
Stool
Any mucus
How much, how. Often, consistency
Systems review
FWAR
GI- dysphagia, n and v, indigestion, abdominal pain, bowel habit change, mucus in stool
ALARMS
Anal fissure
Bleeding on defecation
Bright red on tissue paper
Intense anal pain
Constipation history
Haemorrhoids
Bleeding on defecation
Bright red on toilet paper
Constipation history
Anal pruritus
Diverticulitis haemorrhage
Sudden painless rectal bleeding
Left iliac fossa pain
Elderly
Diverticulitis- fever nausea and vomiting and bloody diarrhoea
Distal malignancy
Alternating bowel habit Fresh blood Weight loss Urgency or tenesmus Anal discomfort
IBD
Blood mixed with stool Mucus Diarrhoea Abdominal pain Weight loss and night time pain
More common in UC than Crohns
Haemorrhagic infective gastroenteritis
Acute diarrhoea and vomiting
History of high risk food intake and travel
Angiodyplasia
Elderly
Painless
Subtle bleeding
Proximal malignancy
Weight loss
Malaena
Anaemia Sx
PUD
Gastritis symptoms
Haematemesis
Risk f actors
Melaena
Oesophageal varices
History of liver disease, alcoholism
Encephalopathy or alcohol withdrawal
Haematemesis
Sequence of events
Open question
Timeline
Symptom analysis
Site- back passage and definitely not from the front
Onset
Character/colour- dark, fresh, on paper or mixed in stool etc.
Radiation to paper/pain- on toilet bowl or in paper
Associated features
Timing- happened before/how frequently
Exacerbating factors- trauma, constipation
Smell- foul smelling, dark or tarry
Systems review
GI- pain, stool, mucus, how often, is that normal, itching, n and v, vomited any blood, mouth ulcers, fever, painful red eye, joint or back pain
Travel- been abroad
Constitutional- FWARJNLCT
Patients perspective
Feelings and impact on life
ICE
Background
PMH (PUD, recent GI surgery, haemorrhoids, IBD and diverticulitis, malignancy)
DH
FH (CRC and ovarian carcinoma)
SH
Gastroenteritis
History of eating uncooked food/foreign travel
Diarrhoea (watery, bloody, loose, vomiting)
Household contacts may be unwell with similar symptoms
Upper GI bleed
Large volume bleed, unwell patient may be haemodynamically unstable
Melaena
Haematemesis and other red flag symptoms
Previous dyspepsia, peptic ulcers, chronic liver disease, long term anti inflammatory use
Investigations for rectal bleeding
Full abdominal examination including PR exam, stool culture and sensitivities if diarrhoea, and faecal cal protection
Bloods- FBC, UE, LFT, clotting, CRP, group and save or cross match if severe
Imaging- sigmoidoscopy, colonoscopy, staging CT abdomen, pelvis (if malignancy suspected on endoscopy)
