Hematochezia

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of hematochezia

Described as ‍bright reddark redmaroon ‍on toilet papercoating stoolin the stool

Blood volume estimated as ‍smallmoderatelargeunclear

Occurred ‍ times ‍per dayoverall

Alleviating factors: ‍nonedietary modifications, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍abdominal pain, ‍diffuse, ‍dull, ‍mild

‍diarrhea, ‍ episodes ‍per day, ‍

‍constipation

‍changes in bowel habits

‍dark, tarry stools

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍bloating

‍weight loss, ‍ ‍lbskg over ‍ ‍weeksmonths, ‍unintentionalintentional

‍fatigue

‍dizziness

‍fainting

‍shortness of breath

‍chest pain, ‍retrosternal, ‍aching, ‍on exertionat restwith deep breath, ‍mild



Contributing factors:

‍heavy drinker

‍recent beets eating

last colonoscopy: ‍ ‍monthsyears ago

no history of: ‍hemorrhoids, ‍anal fissures, ‍diverticular disease, ‍colorectal cancer, ‍inflammatory bowel disease

no use of: ‍anticoagulants, ‍antiplatelets, ‍NSAIDs

no family history of: ‍colorectal cancer





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

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

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Anorectal: DRE ‍normal, prostate ‍normal, ‍blood, ‍mass, anus ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍





ASSESSMENT:

‍Hemorrhoids ‍likelysuspectedpossible

DDx: hemorrhoids, anal fissure, colorectal cancer, gastrointestinal infection, inflammatory bowel disease, diverticulosis, angiodysplasia, polyps, ischemic colitis, proctitis, solitary rectal ulcer syndrome, radiation proctitis, anticoagulant medication side effect, coagulopathy, rectal trauma, upper gastrointestinal bleeding with rapid transit, meckel's diverticulum, endometriosis involving the bowel, post-polypectomy bleeding





PLAN:

Investigations:

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

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

- Colonoscopy

- Abdominal ultrasound

- CT scan of abdomen and pelvis

Treatments:

- IV fluids

- Stop anticoagulants

- Increase fluid intake

- Increase dietary fiber

Further care:

- 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

- Referral to ER if severe abdominal pain, fever, or hemodynamic instability occurs