Rectal Bleeding

Question 1

Upper GI Causes

Answer 1

Upper GI bleed

Gastric Ca

Question 2

Lower GI Causes

Answer 2

Colorectal Ca
Rectal Ca
Haemorrhoids
Anal Fissues
UC

Question 3

Haematology Causes

Answer 3

Bleeding disorder

Anticoagulantion

Question 4

Bedside Ix

Answer 4

PR - examine for anal and rectal Ca

Proctoscopy if indicated

Question 5

Bloods

Answer 5

FBC, haematinics, clotting, UEs, Group and save, INR, LFTs, ESR, Blood film

Question 6

Imaging

Answer 6

Colonoscopy/Gastroscopy

• UC, biopsy for Ca
• Upper GI bleed

CT staging if malignancy
MRI

Question 7

Systems R/V

Answer 7

Skin, eyes, (UC)
Fainting, SOBOE, fatigue (anaemia)
Abdominal pain/mass

Question 8

Fam Hx

Answer 8

Bowel Ca
IBD
Bleeding tendency

Question 9

Social Hx

Answer 9

Diet: meat (colon), fish (gastric)
Smoking
Alcohol (varices)
Travel

Question 10

RED FLAGS

Answer 10

Melaena
Weight loss
Change in bowel habit
Anaemia (SOB, fatigue)
Abdominal/Rectal Mass

Question 11

Drug Hx

Answer 11

NSAIDs
Steroids
Aspirin
Warfarin, NOACs 
- P450 inhibitors if on warfarin