Rectal Bleeding Flashcards
Signs of haemodynamic instability
Hypotension Tachycardia Cool peripheries Tachypnoea Decreased consciousness
How should you categorise causes of rectal bleeding?
By where the blood could have come from:
Anorectal
Colon
Upper GI (can induce rapid peristalsis, hence passed per rectum rather than haematemesis)
Rectal bleeding and recent aortic surgery suggests…
Aortoenteric fistula
Which drugs do you need to ask about in rectal bleeding?
NSAID
Anticoagulants
Steroids (increased risk of peptic ulcers)
Antibiotics (predispose to c.diff)
Signs of chronic blood loss
Anaemia (pallor, koilonychia)
Malignancy (FLAWS)
All patients with rectal bleeding should have which examination?
DRE
Which blood test do you need to do if they are haemodynamically unstable?
Group and save Cross match (urgent)
Long term bleed, blood being digested can cause a rise in…
Urea
Investigations of frank blood per rectum
Colonoscopy (if stable) Mesenteric angiography (if available), if colonoscopy is unable to be performed, this test is useful for detecting angiodysplasia and potentially treating
Which investigation of upper GI should you also consider for rectal bleeding?
Endoscopy
What is a dieaulafoy lesion?
A ruptured sub mucosal artery in the colon that can cause an intermittent bleed.
Often difficult to pick up on imaging
Characteristic appearance of angiodysplasia on endoscopy
Cherry red spot
Treatment of angiodysplasia
Embolisation
Surgical resection
Small amount of dripping blood after passing stool most likely implies
Haemorrhoids
Management of haemorrhoids
Lifestyle = increase fibre, hydrated, avoid straining Medical = creams to reduce pain and itching Surgical = rubber band ligation, injection sclerotherapy
Altered bowel habit, dark red blood, altered bowel habit
Colorectal carcinoma
Relatively large, non painful rectal bleed in an elderly person mops most likely…
Diverticular disease
How do you confirm diverticular disease?
Colonoscopy
LIF pain and rectal bleeding suggests
Diverticulitis
Which drugs increase the risk of diverticular bleeds
NSAIDS e.g. diclofenac
How do you calculate the risk of further bleeds
HAS BLED score
How do you assess if they should go onto warfarin?
CHADSVASC
Management of anal fissure
Medical = high fibre diet, avoid constipation!, osmotic laxatives to soften, topic anaesthetics (lidocaine gel), topical GTN to increase local blood flow
If this fails surgical management Is possible = lateral internal sphincterotomy, but risk of incontinence
How do you classify internal haemorrhoids?
First degree: bleed but do not prolapse
Second: prolapse but reduce spontaneously
Third: prolapse but need to be manually reduced
Fourth: irreducible
Line that delineates the internal anal canal with the external (outside world)
Dentate line
Above the dentate line, the epithelium is what type?
Columnar
Haemorrhoid complications
Thrombosed
Anal fissure
Abscess
Proctalgia fugax (stabbing sensation in anus, more common at night)
Risk factors of colorectal carcinoma
Age
Male rail obesity
Colorectal disease (chronic inflammation e,g, UC)
Familial conditions e.g. FAP, HNPCC
What will ferritin levels be in iron deficiency anaemia
Low
Ferritin levels in anaemia of chronic disease
High
TIBC in anaemia of chronic disease
Low
TIBC in iron deficiency anaemia
High
You have diagnosed haemorrhoids in an elderly person, what must you also consider lurking?
Colorectal carcinoma
Superior mesenteric artery arises at what level
L1
