Investigations

Question 1

What are urgent referral scenarios?

Answer 1

• > 40yo with unexplained abdominal pain and weight loss
• > 50yo with unexplained rectal bleeding
• > 60yo with changes in bowel habit
• > 60yo with unexplained iron deficiency anaemia

Question 2

How do you diagnose IBS?

Answer 2

• If classic history then FBC, ESR, CRP and coeliac serology
• If >60yrs or any marker or organic disease (blood PR. decreased weight) then colonoscopy
• Exclude ovarian cancer with serum Ca-125
• Consider endometriosis if pain is cyclical
• If IBS criteria not met consider stool culture, B12/folate, TSH and faecal calprotectin

Question 3

What are the investigations for IBD?

Answer 3

• Anaemia in IBD
• Barium AXR: crohn’s will have string sign and UC has lead pipe colon
• Stool culture
• FBC + CRP
• Anti-TTG (to rule out coeliac)
• Faecal calprotectin

Question 4

What are the reasons for doing a DRE?

Answer 4

• Suspected appendicitis
• PR bleed
• Change in bowel habits
• Part of abdominal examination
• Genitourinary problems
• Pelvic or spinal trauma