Rectal bleeding and change in bowel habit Flashcards

1
Q

causes of PR bleeding

A
CRC 
IBD - crohn's, UC 
haemorrhoids 
trauma 
gastroenteritis 
fissures 
fistulas 
polyps 
diverticulitis 
ischaemic colitis 
rectal varices
coagulopathy 
radiation proctitis
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2
Q

right sided will show bright occult / dark blood

A

dark

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3
Q

altered bowel habit differentials

A
cancer - CRC, anal, rectal
IBD 
IBS 
overflow diarrhoea 
drugs 
malnutrition 
dehydration 
bowel obstruction 
diverticulitis 
infection
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4
Q

PR bleeding Hx (4 things)

A
rectal bleeding: amount 
colour - fresh/dark
frequency 
duration 
abdo/anal pain

red flags: change in bowel habits (CIBH), weight loss, FH, night sweats

medications - antithrombotics

anaemia symptoms - tired, SOB, pallor, palpitations, hair loss

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5
Q

fissure = painful/less bleeding

A

painful

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6
Q

haemorrhoids = painful/less bleeding

A

painless

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7
Q

examination for PR bleeding

A

abdo exam
PR exam
proctoscopy
flexible/rigid sigmoidoscopy

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8
Q

anal fissure

A
longitudinal ulcer in anal canal 
acute or chronic 
painful bleeding 
streak of blood 
history of constipation and straining 
PR exam
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9
Q

management of anal fissures

A
water 
high fibre 
laxatives 
topical ointments 
botox injections
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10
Q

grading of haemorrhoids

A
1-4 
1 - remain in rectum 
2 - prolapse through anus on defecation but spontaneously reduce
3 - require digital reduction 
4 - remain persistently prolapsed
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11
Q

management of haemorrhoids

A

topical (for itch as it can be drying)
banding
THD
haemorrhoidectomy

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12
Q

what is diverticular disease

A

outpouching of mucosa through bowel wall associated with increased intraluminal pressure
outpouching will only have serosal coverings, weak points that can get inflamed

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13
Q

RF for diverticular disease

A

constipation

low fibre diet

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14
Q

diverticular disease investigations

A

CT
colonoscopy
barium enema

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15
Q

diverticular disease management

A

diet
antibiotics
surgery for perforation or repeated infection

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16
Q

MRI is better for small/large bowel

A

small

17
Q

Colorectal cancer RF

A

genetics

18
Q

Symptoms of CRC

A
tenesmus (rectal Ca)
weight loss 
IDA 
CIBH 
PR bleeding
19
Q

CRC investigations

A
CEA tumour marker 
AXR 
CT 
MRI 
Colonoscopy 
CT colonography
20
Q

management of CRC

A

EMR - endoscopic mucosal resection
surgery
neo/adjuvant chemo/radiotherapy

21
Q

Screening for CRC

A

50-74 yo
2 yearly
QFIT test

22
Q

most common CRC locations

A

Sigmoid and rectal

23
Q

surgical management of CRC

A

right colectomy
left colectomy
sigmoid colectomy

24
Q

surgical management of rectal cancer

A

anterior resection

abdominoperineal resection - low lying rectal tumours

25
Q

surgical palliative options for CRC

A

defunctioning colostomy / ileostomy

stenting

26
Q

Management of acute bowel obstruction

A
ABCDE
IV cannulas - fluids 
NG tube to decompress stomach and avoid aspiration 
catheter
then imaging