Blood in Stool Flashcards
What key history would you obtain from a patient who complains of blood in the stool?
Melena vs bright blood Amount Duration Associated symptoms (constitutional, abdominal or rectal pain, tenesmus, constipation/diarrhea) Trauma Prior history of similar symptoms Prior colonoscopy Medications (especially warfarin) History of easy bleeding or atherosclerotic vascular disease
What key physical exams would you perform on a patient who complains of blood in the stool?
Vital signs including orthostatics
Abdominal and rectal exams
67 yo M presents with blood in his stool, weight loss, and constipation. He has a family history of colon cancer. Differentials?
Colorectal cancer Anal fissure Hemorrhoids Diverticulosis Ischemic bowel disease Angiodysplasia Upper GI bleeding Inflammatory bowel disease
67 yo M presents with blood in his stool, weight loss, and constipation. He has a family history of colon cancer. Differentials: colorectal cancer, anal fissure, hemorrhoids, diverticulosis, ischemic bowel disease, angiodysplasia, upper GI bleeding, inflammatory bowel disease. Workup?
Rectal exam CBC PT/PTT AST/ALT/Bilirubin/Alkaline phosphatase CEA Colonoscopy CT - abdominal/pelvis Barium enema
33 yo F presents with rectal bleeding and diarrhea for the past week. She has had lower abdominal pain and tenesmus for several months. Differentials?
Ulcerative colitis Crohn's disease Proctitis Anal fissure Hemorrhoids Diverticulosis Dysentery
33 yo F presents with rectal bleeding and diarrhea for the past week. She has had lower abdominal pain and tenesmus for several months. Differentials: ulcerative colitis, Crohn’s disease, proctitis, anal fissure, hemorrhoids, diverticulosis, dysentery. Workup?
Rectal exam CBC PT/PTT AXR Colonoscopy CT - abdomen/pelvis Barium enema
58 yo M presents with bright red blood per rectum and chronic constipation. He consumes a low-fiber diet. Differentials?
Diverticulosis Anal fissure Hemorrhoids Angiodysplasia Colorectal cancer
58 yo M presents with bright red blood per rectum and chronic constipation. He consumes a low-fiber diet. Differentials: diverticulosis, anal fissure, hemorrhoids, angiodysplasia, colorectal cancer. Workup?
Rectal exam CBC PT/PTT Electrolytes Colonoscopy CT - abdomen/pelvis
