rectal bleeding
| See Dysentery | |
|---|---|
| History | • How much, nature of bleeding (e.g. blood mixed in? • Malaena - quantity+duration? Tenesmus? • Children: vomiting? If so – bilious? NAI???? • FHx – Ca colon, FAP, HNPCC • DHx – NSAIDs, steroids, anticoagulants • Red flags: unintentional weight loss, abdo mass, change in bowel habit |
| Examination | |
| Diagnostic investigations | ➥ CT angio if active bleeding ➥ Abdo USS in children ➥ Intussusception?: flexi sigmoidoscopy ➥ colonoscopy, CT colon |
| Differentials | - Acute diverticulitis, IBD (Crohn’s, UC), polyps, cancer - infective: dysentery i.e. bloody diarrhoea - vascular: angiodysplasia, ischaemic colitis, fistula - Anorectal problems: haemorrhoids, perianal disease e.g. fissures - clotting disorders; drug-induced In children: - ex-prem? necrotising enterocolitis - anal fissure, volvulus, intussusception, Meckel’s diverticulum - Henoch Schonlein purpura, Haemolytic uraemic syndrome |
| Immediate management | Impending bleeding doom if necessary Ischaemic colitis - risk perforation, would warrant operative management |
| Ongoing management |