Rectal bleeding Flashcards

1
Q

Differential diagnoses of Rectal bleeding

A
  1. Hemorrhoids*
Probability diagnosis 
Haemorrhoids/perianal haematoma
Anal fissure
Colorectal polyp 
Diverticulitis
Excoriated skin (anal pruritus)
Serious disorders not to be missed  
Vascular:
•ischaemic colitis
•angiodysplasia (vascular ectasia)
•anticoagulant therapy

Infection:
•enteritis (e.g. Campylobacter, Salmonella)

Cancer/tumours:
•colorectal, caecum
•lymphoma
•villous adenoma

Other:
•inflammatory bowel disease (colitis/proctitis)
•intussusception

Pitfalls (often missed)
Rectal prolapse
Anal trauma (accidental/non-accidental)
Villous adenoma

Rarities:
•Meckel diverticulum
•solitary ulcer of rectum

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2
Q

Rectal Bleeding - Key History

A

Key history

Nature of the bleed, including fresh versus altered blood, mixed with faeces and/or mucus, in toilet bowl or on underwear.
Quantity of bleeding: slight, moderate or torrential.
Associated symptoms (e.g. weight loss, constipation, diarrhoea, pain, weakness, presence of lumps, urgency, unsatisfied defecation, recent change of bowel habit).

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3
Q

Rectal Bleeding - Key PE

A

Key examination

  • General inspection (evidence of anaemia) and vital signs
  • Abnormal examination, anal inspection, digital rectal examination, proctosigmoidoscopy
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4
Q

Rectal Bleeding - Key Investigations

A

Key investigations

  • FBE and ESR
  • Stool M&C
  • Faecal occult blood
  • Colonoscopy
  • Consider abdominal X-ray, CT colonography, angiography, small bowel enema (depending on clinical findings)
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5
Q

Rectal Bleeding - Diagnostic tips

A

Diagnostic tips

  • Black, tarry (melaena) stool indicates bleeding from upper GIT: rare distal to lower ileum.
  • Frequent passage of blood and mucus indicates a rectal tumour or proctitis.
  • If substantial haemorrhage, consider diverticular disease, angiodysplasia or more proximal lesions (e.g. Meckel diverticulum, duodenal ulcers).
  • New bleeding age >55 years demands colonic investigation.
  • 80% of rectal tumours are within fingertip range.
  • In young adults, diagnosis is likely to be haemorrhoids or a fissure.
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