Rectal bleeding and change in bowel habit Flashcards
causes of PR bleeding
CRC IBD - crohn's, UC haemorrhoids trauma gastroenteritis fissures fistulas polyps diverticulitis ischaemic colitis rectal varices coagulopathy radiation proctitis
right sided will show bright occult / dark blood
dark
altered bowel habit differentials
cancer - CRC, anal, rectal IBD IBS overflow diarrhoea drugs malnutrition dehydration bowel obstruction diverticulitis infection
PR bleeding Hx (4 things)
rectal bleeding: amount colour - fresh/dark frequency duration abdo/anal pain
red flags: change in bowel habits (CIBH), weight loss, FH, night sweats
medications - antithrombotics
anaemia symptoms - tired, SOB, pallor, palpitations, hair loss
fissure = painful/less bleeding
painful
haemorrhoids = painful/less bleeding
painless
examination for PR bleeding
abdo exam
PR exam
proctoscopy
flexible/rigid sigmoidoscopy
anal fissure
longitudinal ulcer in anal canal acute or chronic painful bleeding streak of blood history of constipation and straining PR exam
management of anal fissures
water high fibre laxatives topical ointments botox injections
grading of haemorrhoids
1-4 1 - remain in rectum 2 - prolapse through anus on defecation but spontaneously reduce 3 - require digital reduction 4 - remain persistently prolapsed
management of haemorrhoids
topical (for itch as it can be drying)
banding
THD
haemorrhoidectomy
what is diverticular disease
outpouching of mucosa through bowel wall associated with increased intraluminal pressure
outpouching will only have serosal coverings, weak points that can get inflamed
RF for diverticular disease
constipation
low fibre diet
diverticular disease investigations
CT
colonoscopy
barium enema
diverticular disease management
diet
antibiotics
surgery for perforation or repeated infection
MRI is better for small/large bowel
small
Colorectal cancer RF
genetics
Symptoms of CRC
tenesmus (rectal Ca) weight loss IDA CIBH PR bleeding
CRC investigations
CEA tumour marker AXR CT MRI Colonoscopy CT colonography
management of CRC
EMR - endoscopic mucosal resection
surgery
neo/adjuvant chemo/radiotherapy
Screening for CRC
50-74 yo
2 yearly
QFIT test
most common CRC locations
Sigmoid and rectal
surgical management of CRC
right colectomy
left colectomy
sigmoid colectomy
surgical management of rectal cancer
anterior resection
abdominoperineal resection - low lying rectal tumours
surgical palliative options for CRC
defunctioning colostomy / ileostomy
stenting
Management of acute bowel obstruction
ABCDE IV cannulas - fluids NG tube to decompress stomach and avoid aspiration catheter then imaging
