21. Rectal bleeding

Question 1

Answer 1

Question 2

Answer 2

There are a couple of points to note about this differential diagnosis. GI haemorrhage may present as overt or occult bleeding. This table, and the indications of prevalence within it, refers to overt rectal bleeding as occult rectal bleeding will not be noticed by the patient. The second point to note is that upper GI sources of haemorrhage may occasionally present with rectal bleeding alone. Although it is more likely that such upper GI sources will also present with haematemesis, you should note that large volumes of blood in the GI tract can act as a cathartic (stimulant of peristalsis) and the resultant rapid transit through the intestine leads to the passage of red blood per rectum.

Question 3

What questions would you like to ask specifically regarding the history of the presenting complaint (rectal bleeding?

Answer 3

Question 4

Answer 4

Question 5

What is the specific relevance of past medical/surgical history in a patient presenting with rectal bleeding?
= 6 points

Answer 5

Question 6

4 Medications to ask about during history taking in a patient presenting with rectal bleeding?

Answer 6

Question 7

Answer 7

Question 8

Answer 8

Question 9

= 4 investigations

Answer 9

Question 10

Outline an algorithm for the investigation of a patient with acute rectal bleeding.

Answer 10

Question 11

Does a patient with acute rectal bleeding need an upper GI endoscopy? Are there any other imaging modalities you might consider?

Answer 11

Question 12

Answer 12

Question 13

• Lifestyle modification? (3)
• Medical management? (4)
• Surgical management? (6)

Answer 13

Mr Barnes is suffering from internal haemorrhoids.

Question 14

Answer 14

Question 15

Answer 15

Question 16

List 3 surgical options for diverticular disease?

Answer 16

Question 17

Medical management? (4)
Surgical management? (2)

Answer 17

Question 18

What is the anatomical definition of a lower GI haemorrhage?

Answer 18

Question 19

How do you classify internal haemorrhoids? (I-IV)

Answer 19

Question 20

What is the significance of the dentate line? What are the zones of the anal canal?

Answer 20

Question 21

What is the difference between diverticlosis, diverticular disease and diverticulitis?

Answer 21

Question 22

= 5

Answer 22

Question 23

List 12 known risk factors for colorectal carcinoma?

Answer 23

Question 24

Answer 24

Question 25

3s

Answer 25

Question 26

Answer 26

Question 27

Answer 27