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Rectal And Perianal Bleeding

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Rectal And Perianal Bleeding

  1. 1. Rectal And Perianal Bleeding Ben Savage
  2. 2. Objectives  History  Examination  Tests  Differential diagnosis
  3. 3. History  Take a good history with key questions:  Description of bleeding:  Colour, amount, relationship to passage of stools.  Where is blood seen:  Distal. Blood on bowel not on stool, spotting on toilet paper  L Fresh and on outer surface of stool  L Mixed in with stool  Proximal. Black tarry stool (malaena)
  4. 4. History  Haematemesis  Previous GI bleeds  Hx of ulcers  Drugs (NSAIDs)
  5. 5. History  Malignancy  Trauma  Mental illness- ingestion of foreign bodies.
  6. 6. Examination  Relevant examination inc PR  Patient maybe perfectly well.  Check for signs and symptoms of systemic illness  Assess lymph nodes. (Virchow’s node)  NB/ If large amounts of blood being lost  Acute = Shock  Chronic = Anaemia
  7. 7. Tests  Bloods  FBC, U&E, LFT, CRP,  Stool sample  Microscopy and cultures  CXR / AXR  CT /MRI  Barium study  Endoscopy +/- biopsy
  8. 8. Differential Diagnosis  Malaena –Upper GI bleed  Ulceration  Reflux oesophagitis  Oesophageal varices  Mallory-Weiss tear  Carcinoma
  9. 9. Differential Diagnosis  Mixed in with stool – High rectal bleed  Haemorrhoids  IBD  Polyps  Carcinoma
  10. 10. Differential Diagnosis  Separate from stool – Low rectal bleed  Haemorrhoids  IBD  Diverticular disease  Anorectal carcinoma  Anal tear
  11. 11. Differential Diagnosis  Spotting  Haemorrhoids  Anal tear  Anal fistula
  12. 12. Thank you Any Questions

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