Page 1 of 1: OSCE-Buster: Rectal bleeding history

bookworm · Credits: 6308 My Scrapbook

Introduction:

Since when have you been passing blood per rectum?

Is this the first episode?

Is it frank blood or blood in the stool? Are you passing any slime?

How many times do you open your bowel?

Do you feel any thing coming down while passing bowels?

Do you have to strain to pass your motion (Tenesmus)? Pain while passing the bowels? Fever?

Abdominal pain? Do you fell well after opening the bowel?

Appetite? Weight loss? Arthritis?

Are you on any medication?
Medical history of IBD, Ca and bleeding disorders?
Alcohol, smoking and drugs?

Do any one in your family have similar complaints?

DD: diverticulitis, colorectal carcinoma, haemorrhoids, polyps, trauma, fissure in ano, angiodysplasia, arteriovenous malformation, radiation proctitis.

bookworm · Credits: 6308 My Scrapbook

4M 7 SISTER

Introduction, and then you may say: as far as I know you are passing blood (having bleeding) from your back passage. I would like to ask you a few questions then we will talk about what we will do. How long have you had the bleeding? (Duration) How much blood did you pass? (Amount) Is the blood mixed with or on the surface of stool? Can you tell me the colour of the blood? Is it bright red or dark red or black? Do you feel urge to pass motion? Do you feel the need to pass motion and when you try nothing comes out? Do you have any pain during passing motion? Does the blood come before, during, or after passing motion? Any blood on toilet paper or pants? Have you passed any pus, mucous or discharge with stool? Did you notice any lump passing from your back passage? Do you have any tummy pain? Do you have any changes in your bowel habit? Any diarrhoea? Constipation? Do you feel any distension of your tummy? Passing wind more than usual? Any fever (temperature)? Have you lost weight recently? Felt sick? (Nausea) Been sick? (Vomiting) Have you had similar condition in the past? Do you have bleeding from any other site? Do you have any disease? Are on any medication? Have you travelled abroad? Do you eat a lot of vegetables and fruits? Has anyone else in your family had similar condition? Any bowel disease or tumour in your relatives? Differential diagnosis: Colon and rectal carcinomas. Diverticular diseases Haemorrhoids Inflammatory bowel diseases ( Crohn’s disease and Ulcerative Colitis) Anal fissure Angiodysplasia Proctitis Polyps Bleeding disorders

James444 · Credits: 932 My Scrapbook

Thanks for that detailed elaboration. What about rectal bleeding in children? Anyone?

Red_Nurse · Credits: 137 My Scrapbook

Why does everyone forget to ask the age? ;P

O onset.

Since when have you been bleeding?
Were you well previously?
Has it happened before?
Is it getting worse?

C Character.

How much are you bleeding? ( quantify it by asking "is it visible just on the toilet paper? in the toilet bowel water? is there blood on the surface of the poo or is it mixed with the poo?")

Do you bleed every time you go to the bathroom? or just some of the time? (is is constant or transient?)

Is the blood bright red? dark red? are you passing black tarry feces?

A associated symptoms.

Is there a history of nose bleeds, coughing up blood?

Remember to ask if these associated symptoms came first or second to the bleeding.

Are you nauseated? have you vomited (describe it, was there blood, etc)? have you lost weight, what's you appetite like? (if yes, ask more about that symptom/s)

Do you have:

a fever? night sweets?

difficulty swallowing? reflux and heardburn?

bloating, distention?

abdo pain? (is yes, ask away all about it site, onset, character, etc)

jaundice, dark urine, pale feces, itchy skin, increased abdo girth (has your belt size increased lately?)

is there diarrhea? is there mucus?

is there pain on passing feces?

Is there constipation?

arthralgia, rashes, red eyes, eye pain?

does bleeding occur before passing poo, during or after?

does it feel like there the bowels are not empty even after passing feces? (tenesmus)

Precipitating factors.

History of trauma to the anal canal, abuse?

ask about symptoms of anemia.
ask about symptoms of fluid depletion.

Past Med Hx.

Previous diagnosis of Crohn's, ulcerative colitis.

recent removal of polyps?

Any recent endoscopies? Any biopsies taken by endoscopy? bleeding very common after adenoma removed.

do you have a bleeding disorder? Do you bruise easily? do you bleed from any other sites?

have you had radiotherapy around the abdomen/ pelvis (radiation proctatitis can occur years after the treatment)

history of heart disease? (mesenteric infarction)

gastroenteritis?

Drug Hx.

allergies
prescription drugs.
over the counter drugs
alternative, herbs
antibiotics (think of overgrowth syndromes)

ask specifically about:
anticoagulants?
iron tablets?
steriods

Social Hx.

overseas travel.
time off work because of this symptom, how has it been affecting your life?

Fam Hx.

is there a family history of colon ca., polyps, inflammatory bowel disease?

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I'd to a paediatric lower GI bleeding history exactly the same, although I'd also ask about milesones and development and the mother's obstetric Hx.

tezb · Credits: 6246 My Scrapbook

Tenesmus is the feeling of incomplete evacuation after passing a stool (ie feel like something is there even once they have finished)...

Straining at the stool is not tenesmus.

Roche · Credits: 1185 My Scrapbook

Thanks for that.

nsa · Credits: 2227 My Scrapbook

should'nt we also take a menstrual history if the patient is a female..and add endometriosis involving the rectum to the DD..

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