Rectal bleeding and bum stuff Flashcards Preview

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Flashcards in Rectal bleeding and bum stuff Deck (31):
1

Bright red or mixed blood
Hx: bleeding that is accompanied by other symptoms such as altered bowel habit, malaise, history of fissures (especially anterior) and abscesses

Crohns

2

Bright red bleeding, often mixed with stool
Hx: Diarrhoea, weight loss, nocturnal incontinence, passage of mucous PR

Ulcerative colitis

(perianal disease is usually absent)

3

Bright red blood mixed volumes
Hx: alteration of bowel habit. Tenesmus may be present. Symptoms of metastatic disease

Rectal cancer

4

Bright red rectal bleeding.
Hx: post defecation bleeding noted both on toilet paper and drips into pan. May be altered bowel habit and history of straining. No blood mixed with stool, no local pain.

Haemorroids
-usually impalpable

5

Bright red rectal bleeding.
Hx: Painful bleeding that occurs post defecation in small volumes. Usually antecedent features of constipation.

Fissure in ano

6

Investigation for rectal bleeding

All patients presenting with rectal bleeding require a digital rectal examination and procto-sigmoidoscopy as minimal baseline.

IF FEATURES OF ALTERED BOWEL HABIT or suspicion of inflammatory bowel disease -> MUST DO COLONOSCOPY AS BASE TEST

In young patients with fissure, it is acceptable to treat medically and defer internal examination until the fissure is healed

7

Grade 1 haemorrhoid

Do not prolapse out of the anal canal

8

Grade 2 haemorrhoid

Prolapse on defecation but reduce spontaneously

9

Grade 3 haemorrhoid

Can be manually reduced

10

Grade 4 haemorrhoid

Cannot be reduced

11

Examination reveals a purplish, oedematous, tender subcutaneous perianal mass.
Lots of pain

Acutely thrombosed external haemorrhage

(if patient presents within 72 hours, then referral can be made for excision. Otherwise give stool softeners, ice packs and analgesia)

Symptoms should settle within 10 days

12

Treatment for anal cancer

Chemoradiotherapy

13

Nocturnal diarrhoea and incontinence are typical of what?

Inflammatory bowel disease

14

Name some patients who might need a temporary stoma?

Patients who have an anterior resection often need a temporary stoma for a few weeks or months to allow the join in the rectum to heal

15

When is a hartmanns procedure normally performed and what is it?

Normally performed in an emergency - sigmoid and upper rectum are removed and an end colostomy formed

16

Risk factors for caecal volvulus and what does it look like on x-ray?

X-ray will show a large dilated loop of bowel centrally

Risk factors include adhesions secondary to Crohns disease and previous surgery

17

Which condition are you likely to see toxic megacolon in?

Ulcerative colitis

18

Location 3,7, 11 o'clock position
Internal or external

Haemorrhoids

19

Location: midline 6 (posterior midline 90%) & 12 o'clock position. Distal to the dentate line
Chronic fissure > 6/52: triad: Ulcer, sentinel pile, enlarged anal papillae

Fissure in ano

20

Causes of proctitis

Crohn's, ulcerative colitis, clostridium difficile

21

Which bacteria are responsible for ano rectal abscess?

E. coli, staph aureus

22

Why might you get an anal fistula?

If you've had previous anorectal abscesses

23

Associated with childbirth and rectal intussception

Rectal prolapse

24

Difference between anal and rectal cancer?

Anal cancer - squamous
Rectal cancer - adenocarcinoma

25

Associated with chronic straining and constipation. Histology shows mucosal thickening, lamina propria replaced with collagen and smooth muscle (fibromuscular obliteration)

Solitary rectal ulcer

26

Difference between bum cancer screening in scotland and england

Scotland care for you and screen from 50-74
England don't and only screen from 60-74

Send poo every two years

27

Treatment for haemorrhoids

Soften stools - increase dietary fibre and fluid intake
Topical local anaesthetics and steroids may be used to help symptoms
(NOTE IN ANAL FISSURES STEROIDS ARE USELESS)

28

A 74 year old lady has been admitted with sudden onset profuse dark red rectal bleeding, she was previously well. At time of assessment her bleeding had stopped but haemoglobin was 10.5

Diverticular bleed
- this pattern of sudden onset profuse bleeding is typical of diverticular bleeding - this often ceases spontaneously.

29

A 56 year old lady has undergone a Hartman's procedure for diverticulitis. 6 months post operatively she complains of painless passage of blood stained mucous per rectum.

Diversion proctitis - rectal diversion may result in proctitis

30

Investigation to check anastamosis (e.g. in anstamosis performed to attach colon to rectum)

Gastrogafin enema
(water soluble radiopaque liquid)

31

Treatment for pseudo-obstruction

Anti-muscarinics