General: PR Bleeding Flashcards Preview

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Flashcards in General: PR Bleeding Deck (7)
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1
Q

What causes PR bleeding?

A

Diverticular disease = symptomatic outpouching of bowel wall

Angiodysplasia = small vascular malformation of the gut

Haemorrhoids = swollen and inflamed veins

Malignancy = colorectal cancer

Stomach ulcer

Anal fissures

IBD

Ischemic colitis

Aorto-enteric fistula

2
Q

What are the important clinical features of PR bleeding that need to be ascertained?

A

Nature of bleeding = duration, frequency, colour of the bleeding, relation to stool and defecation

Associated symptoms = including pain (whether it wakes them at night, is relieved or worsened by defaecation), haematemesis, mucus, previous episodes

FH = bowel cancer or IBD

3
Q

How should PR bleeding be investigated?

A

Hx = other lower GI symptoms, weight loss, or relevant family history

Flexible sigmoidoscopy or colonoscopy = exclude left-colonic malignancy

PR

Bloods = FBC, U+Es, LFT, coag, group and save

Stool cultures = exclude infection

Angiogram = dentification of culprit bleeding vessels and also permits for therapeutic intervention

Haemodynamically unstable = oesophago-gastroduodenoscopy (OGD) +/- CT angiogram with embolisation

4
Q

How should PR bleeding be managed?

A

A-E assessment = gaining 2 large bore cannulae, IV fluid, and blood products (if required)

95% of cases will settle spontaneously = bleeding stopped, normal Hb = discharge + investigate as outpatient

Unstable = resuscitation and urgent endoscopy and CT angiogram

5
Q

What are the possible complications from PR bleeding?

A

Anaemia = dizziness, fatigue, weakness, headaches, SOB

Becoming haemodynamically unstable

Dehydration

6
Q

What are haemorrhoids?

A

Raise in intra-abdo pressure = obstructs venous return = venous plexus engorges

Bulging mucosa is then dragged distally by hard stool

3, 7, 11 o’clock positions = correspond to the anal cushion positions

7
Q

How are haemorrhoids classified?

A

First degree = piles never prolapse

Second degree = piles prolapse during defaecation and then return

Third degree = piles remain outside the anal margin unless replaced digitally

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