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Oxford Clinical Cases > Rectal Bleeding > Flashcards

Rectal Bleeding Flashcards

1
Q

Signs of haemodynamic instability

A 
Hypotension 
Tachycardia 
Cool peripheries 
Tachypnoea 
Decreased consciousness
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2
Q

How should you categorise causes of rectal bleeding?

A

By where the blood could have come from:
Anorectal
Colon
Upper GI (can induce rapid peristalsis, hence passed per rectum rather than haematemesis)

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3
Q

Rectal bleeding and recent aortic surgery suggests…

A

Aortoenteric fistula

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4
Q

Which drugs do you need to ask about in rectal bleeding?

A

NSAID
Anticoagulants
Steroids (increased risk of peptic ulcers)
Antibiotics (predispose to c.diff)

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5
Q

Signs of chronic blood loss

A

Anaemia (pallor, koilonychia)

Malignancy (FLAWS)

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6
Q

All patients with rectal bleeding should have which examination?

A

DRE

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7
Q

Which blood test do you need to do if they are haemodynamically unstable?

A 
Group and save 
Cross match (urgent)
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8
Q

Long term bleed, blood being digested can cause a rise in…

A

Urea

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9
Q

Investigations of frank blood per rectum

A 
Colonoscopy (if stable) 
Mesenteric angiography (if available), if colonoscopy is unable to be performed, this test is useful for detecting angiodysplasia and potentially treating
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10
Q

Which investigation of upper GI should you also consider for rectal bleeding?

A

Endoscopy

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11
Q

What is a dieaulafoy lesion?

A

A ruptured sub mucosal artery in the colon that can cause an intermittent bleed.
Often difficult to pick up on imaging

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12
Q

Characteristic appearance of angiodysplasia on endoscopy

A

Cherry red spot

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13
Q

Treatment of angiodysplasia

A

Embolisation

Surgical resection

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14
Q

Small amount of dripping blood after passing stool most likely implies

A

Haemorrhoids

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15
Q

Management of haemorrhoids

A 
Lifestyle = increase fibre, hydrated, avoid straining
Medical = creams to reduce pain and itching 
Surgical = rubber band ligation, injection sclerotherapy
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16
Q

Altered bowel habit, dark red blood, altered bowel habit

A

Colorectal carcinoma

17
Q

Relatively large, non painful rectal bleed in an elderly person mops most likely…

A

Diverticular disease

18
Q

How do you confirm diverticular disease?

A

Colonoscopy

19
Q

LIF pain and rectal bleeding suggests

A

Diverticulitis

20
Q

Which drugs increase the risk of diverticular bleeds

A

NSAIDS e.g. diclofenac

21
Q

How do you calculate the risk of further bleeds

A

HAS BLED score

22
Q

How do you assess if they should go onto warfarin?

A

CHADSVASC

23
Q

Management of anal fissure

A

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

24
Q

How do you classify internal haemorrhoids?

A

First degree: bleed but do not prolapse
Second: prolapse but reduce spontaneously
Third: prolapse but need to be manually reduced
Fourth: irreducible

25
Q

Line that delineates the internal anal canal with the external (outside world)

A

Dentate line

26
Q

Above the dentate line, the epithelium is what type?

A

Columnar

27
Q

Haemorrhoid complications

A

Thrombosed
Anal fissure
Abscess
Proctalgia fugax (stabbing sensation in anus, more common at night)

28
Q

Risk factors of colorectal carcinoma

A

Age
Male rail obesity
Colorectal disease (chronic inflammation e,g, UC)
Familial conditions e.g. FAP, HNPCC

29
Q

What will ferritin levels be in iron deficiency anaemia

A

Low

30
Q

Ferritin levels in anaemia of chronic disease

A

High

31
Q

TIBC in anaemia of chronic disease

A

Low

32
Q

TIBC in iron deficiency anaemia

A

High

33
Q

You have diagnosed haemorrhoids in an elderly person, what must you also consider lurking?

A

Colorectal carcinoma

34
Q

Superior mesenteric artery arises at what level

A

L1

Oxford Clinical Cases (11 decks)

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