Rectal Bleeding

HISTORY:

Rectal bleeding for ‍ ‍hoursdays

Type: ‍bright reddark redmaroon ‍on toilet paperin the stoolcoating the stool

Volume: ‍smallmoderatelargeunclear

Episodes: ‍ times ‍per dayoverall

Treatments tried: ‍nonediet changesitz bathstopical medications, ‍effectiveineffective

‍abdominal pain, ‍diffuse, ‍dull, ‍mild

‍diarrhea, ‍ episodes ‍per day, ‍

‍constipation

‍changes in bowel habits

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍

‍hematemesis

‍weight loss, ‍ ‍lbskg over ‍ ‍weeksmonths, ‍unintentionalintentional

‍fatigue

‍dizziness

‍mucus or pus in stool

‍anal pain

Last colonoscopy: ‍ ‍monthsyears ago



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normallymphadenopathy

Heart: ‍RRR, ‍normal S1 and S2

Lungs: ‍clearabnormal sounds, ‍retractions

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

Anorectal: DRE ‍normal, prostate ‍normal, anus ‍normal

Extremities: ‍edema, ‍warm, cap refill ‍< 3 sec> 3 sec, pulses ‍normal, ‍



ASSESSMENT:

‍Hemorrhoids ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Blood work: ‍CBC, ‍CRP, ‍electrolytes, ‍creatinine, ‍LFTs, ‍coagulation profile

- Stools: ‍FIT test, ‍bacterial culture, ‍parasitic culture, ‍C. difficile toxin

- Abdominal ultrasound

- Colonoscopy

- CT scan of abdomen and pelvis

- ‍GI medications

- Increase fluid intake

- Increase dietary fiber

- Stop anticoagulants

- Referral to gastroenterologist

- Referral to general surgeon

- Follow-up in ‍ ‍daysweeks

- Return if bleeding worsens, if new symptoms develop such as abdominal pain or weight loss, or if symptoms do not improve with treatment

- Go to ER if severe abdominal pain, severe vomiting, or fever occurs