RECTAL BLEEDING

Ask the Following Questions:

1. Is it severe? The presence of severe rectal bleeding would suggest ulcerative colitis, amebic dysentery, bacillary dysentery, intussusception, mesenteric thrombosis or embolism, diverticulitis, ischemic colitis, and coagulation disorders.
2. Is there diarrhea and/or mucus? The presence of diarrhea with or without mucus would suggest ulcerative colitis, amebic dysentery, or bacillary dysentery.
3. Are there signs of intestinal obstruction? The presence of signs of intestinal obstruction would suggest intussusception, mesenteric thrombosis, or embolism.
4. If the bleeding is mild, is the bleeding mixed well with the stools? Rectal bleeding that is mixed well with the stools suggests carcinoma of the colon, ulcerative colitis, Crohn's disease, Meckel's diverticulum, diverticulitis, and coagulation disorder.
5. Are there painful bowel movements? The presence of painful bowel movements, especially with bright red bleeding, would suggest anal fissure or thrombosed hemorrhoid.
6. Is there a rectal mass? The presence of a rectal mass would suggest a polyp, carcinoma, or internal hemorrhoids.

DIAGNOSTIC WORKUP

Most cases can be diagnosed by anoscopy, sigmoidoscopy, and a barium enema. A stool culture and examination for ovum and parasites should also be done. If the diagnosis is uncertain after these studies, referral to a gastroenterologist should be done for colonoscopy and other diagnostic studies. The gastroenterologist may order angiography or small intestinal enteroscopy as well as radioisotope studies.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.

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• Back to symptom: Bloody stool: Introduction (review 389 causes)
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More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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