This document discusses rectal and perianal bleeding. It begins by outlining the objectives, history, examination, tests, and differential diagnosis. For history, it describes key questions about the color, amount and relationship to stools of the bleeding. Examination includes a PR exam and checking for signs of systemic illness or lymph node involvement. Tests include bloodwork, stool samples, imaging like CT/MRI, and endoscopy with biopsy. The differential diagnosis section lists possible causes depending on where the blood is seen, such as hemorrhoids, IBD, diverticulitis, or anal tear.

1. Rectal And Perianal Bleeding
Ben Savage

2. Objectives
 History
 Examination
 Tests
 Differential diagnosis

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. History
 Haematemesis
 Previous GI bleeds
 Hx of ulcers
 Drugs (NSAIDs)

5. History
 Malignancy
 Trauma
 Mental illness- ingestion of foreign bodies.

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. Tests
 Bloods
 FBC, U&E, LFT, CRP,
 Stool sample
 Microscopy and cultures
 CXR / AXR
 CT /MRI
 Barium study
 Endoscopy +/- biopsy

8. Differential Diagnosis
 Malaena –Upper GI bleed
 Ulceration
 Reflux oesophagitis
 Oesophageal varices
 Mallory-Weiss tear
 Carcinoma

9. Differential Diagnosis
 Mixed in with stool – High rectal bleed
 Haemorrhoids
 IBD
 Polyps
 Carcinoma

10. Differential Diagnosis
 Separate from stool – Low rectal bleed
 Haemorrhoids
 IBD
 Diverticular disease
 Anorectal carcinoma
 Anal tear

11. Differential Diagnosis
 Spotting
 Haemorrhoids
 Anal tear
 Anal fistula

12. Thank you
Any Questions