Rectal Bleeding

Question 1

where is the site of bleeding if:

• bright red?
• dark red?
• malaena?

Answer 1

bright red = rectal anal canal origin

dark red = lower GI

malaena = gastro-duodenal source (upper GI)

Question 2

Fissure In Ano

• what type of rectal bleed?
• what is it?
• what % are posterior?
• if it’s anterior - due to what?
• Tx? 1st line and 2nd line

Answer 2

• bright red rectal bleed
• painful tear due to hard faeces, painful bleeding post defecation
• 90%
• underlying disease
• 1st line: GTN 0.2% cream or diltiazem
  2nd line: botulinum toxin

Question 3

Haemorrhoids

• type of rectal bleed?
• bleeding on paper or in pan?
• due to?
• are internal haemorrhoids palpable?
• Tx: conservative? internal haemorrhoids? external haemorrhoids?

Answer 3

• bright red
• potentially both but not mixed in with stool
• constipation and prolonged straining
• no
• conservative: fluid^^, fibre^^
• internal: rubber band ligation
• external: haemorrhoidectomy

Question 4

Crohn’s Disease

• bright red blood or mixed in with stools?
• will have a hx of which type of fissures?
• perianal inspection will show?

Answer 4

• both
• anterior fissures
• fissures and fistulae

-

Question 5

UC

• bright red or mixed in with stool?
• most marked finding of UC with this presentation?
• is there perianal disease like with crohn’s?

Answer 5

• mixed in with stool
• proctitis
• no

Question 6

Rectal Cancer

• bright red or mixed in?
• tenesmus?
• Tx?

Answer 6

• bright red
• yes
• anterior resection with pre-operative radiotherapy

Question 7

all patients with rectal bleeding require as baseline? (2things)

if presenting with altered bowel habit/suspicion of IBD then what is better?

Answer 7

digital rectal examination
procto-sigmoidoscopy

colonoscopy

Question 8

o In young patients with external visible fissure and a compatible history - would you do an internal examination?

Answer 8

No - medical treatment is suitable and defer internal examination but if fails to heal then do internal exam.