Flashcards in Rectal bleeding and bum stuff Deck (31):
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
Bright red bleeding, often mixed with stool
Hx: Diarrhoea, weight loss, nocturnal incontinence, passage of mucous PR
(perianal disease is usually absent)
Bright red blood mixed volumes
Hx: alteration of bowel habit. Tenesmus may be present. Symptoms of metastatic disease
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.
Bright red rectal bleeding.
Hx: Painful bleeding that occurs post defecation in small volumes. Usually antecedent features of constipation.
Fissure in ano
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
Grade 1 haemorrhoid
Do not prolapse out of the anal canal
Grade 2 haemorrhoid
Prolapse on defecation but reduce spontaneously
Grade 3 haemorrhoid
Can be manually reduced
Grade 4 haemorrhoid
Cannot be reduced
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
Treatment for anal cancer
Nocturnal diarrhoea and incontinence are typical of what?
Inflammatory bowel disease
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
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
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
Which condition are you likely to see toxic megacolon in?
Location 3,7, 11 o'clock position
Internal or external
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
Causes of proctitis
Crohn's, ulcerative colitis, clostridium difficile
Which bacteria are responsible for ano rectal abscess?
E. coli, staph aureus
Why might you get an anal fistula?
If you've had previous anorectal abscesses
Associated with childbirth and rectal intussception
Difference between anal and rectal cancer?
Anal cancer - squamous
Rectal cancer - adenocarcinoma
Associated with chronic straining and constipation. Histology shows mucosal thickening, lamina propria replaced with collagen and smooth muscle (fibromuscular obliteration)
Solitary rectal ulcer
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
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)
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
- this pattern of sudden onset profuse bleeding is typical of diverticular bleeding - this often ceases spontaneously.
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
Investigation to check anastamosis (e.g. in anstamosis performed to attach colon to rectum)
(water soluble radiopaque liquid)