1. Rectal And Perianal Bleeding
Ben Savage

2. Objectives
 History
 Examination
 Tests
 Differential diagnosis

3. History
 Take a good history with key questions:
 Description of bleeding:
 Colour, amount, relationship to passage of stools.
 Where is blood seen:
 Distal. Blood on bowel not on stool, spotting
on toilet paper
 L Fresh and on outer surface of stool
 L Mixed in with stool
 Proximal. Black tarry stool (malaena)

4. History
 Haematemesis
 Previous GI bleeds
 Hx of ulcers
 Drugs (NSAIDs)

5. History
 Malignancy
 Trauma
 Mental illness- ingestion of foreign bodies.

6. Examination
 Relevant examination inc PR
 Patient maybe perfectly well.
 Check for signs and symptoms of systemic
illness
 Assess lymph nodes. (Virchow’s node)
 NB/ If large amounts of blood being lost

Acute = Shock

Chronic = Anaemia

7. Tests
 Bloods
 FBC, U&E, LFT, CRP,
 Stool sample
 Microscopy and cultures
 CXR / AXR
 CT /MRI
 Barium study
 Endoscopy +/- biopsy

8. Differential Diagnosis
 Malaena –Upper GI bleed
 Ulceration
 Reflux oesophagitis
 Oesophageal varices
 Mallory-Weiss tear
 Carcinoma

9. Differential Diagnosis
 Mixed in with stool – High rectal bleed
 Haemorrhoids
 IBD
 Polyps
 Carcinoma

10. Differential Diagnosis
 Separate from stool – Low rectal bleed
 Haemorrhoids
 IBD
 Diverticular disease
 Anorectal carcinoma
 Anal tear

11. Differential Diagnosis
 Spotting
 Haemorrhoids
 Anal tear
 Anal fistula

12. Thank you
Any Questions