Rectal Bleeding - Heamatochezia

Question 1

Site

Answer 1

Associated pain

Question 2

Quality

Answer 2

Could you describe your stools?
What colour are your stools?
Is the blood on the outside of the stool or mixed in with your stools?
Is the blood on the toilet paper or in the bowl?

Question 3

Severity

Answer 3

I know it can be difficult to estimate but could you tell me how much blood you are passing?

Question 4

Time course

Answer 4

How long have you been passing blood for?
Has it been getting worse?
Is there blood every time?
Has this ever happened before?

Question 5

Context

Answer 5

What were you doing before the bleeding started?

Have there been any changes to your diet or medication?

Question 6

Relieving Factors

Answer 6

Is there anything that makes it better?

Have you tried taking anything to make it better?

Question 7

Aggravating Factors

Answer 7

Is there anything else that makes it worse?

Question 8

Associated Features

Answer 8

Do you notice anything else with the bleeding?
Have you noticed any change in bowel habits?
Pain, is it local or abdominal?
Unsatisfied defecation?
Medications?
Tendency to bleed?

Question 9

Differential Diagnosis

Answer 9

Bowel Cancer – family history, past history, dark red blood in stools, weight loss, fever

Melaena – black stools

Haemorrhoids – Bright red blood, pain when passing stools, age

Anal Fissure – Bright red blood, sharp pain when passing stools

Question 10

What are we looking for in associated features?

Answer 10

Constipation
Abdominal Pain
Anaemia (pail, dizzy, etc) Vomiting/ Nausea 
Fever 
Loss of appetite

Question 11

All

Answer 11

All