Dr.

Ahmed Albasiouny

BLEEDING PER
RECTUM 2
Case 1
Male pt 43 year old accountant who presented to
his family doctor complaining of rectal bleeding.
His history went back about 7 weeks when he
noticed there were streaks of bright red blood
coating his stool and spots of blood on the toilet
paper from time to time. There was also itching
.around his anus on many days
History
 Personal history
43 years old, male.
 Main complain / duration
Rectal bleeding for 7 days.
 History of present illness
Gradually, increasing, 2 to 3 times per day, 3 to 4 towels, fresh blood after
defecating, increased with straining & decreased with laxatives.
 Associated symptoms
Itching, constipation.
 Past history:
unremarkable
 Family history :
unremarkable
 Social History:
Accountant, low fiber diet
:Examination
 Inspection
May be visible if grade 4
Or 2 to 4 with straining
 Palpation
May be felt during palpation
 Inspection
Blood

Proctoscope may be used

Management
Investigation:
CBC to check for anemia

 Treatment:
1- life style modification
2- medical
3-Procedures
4-Surgery
Case 2
A  female  patient  of  36
years  old  who  came  with  the  chief complaint
of burning pain of Rectum for long time after
stool with bleeding during defecation. She also
.have complaints of Hard stool
History
 Personal history
36 year, female.
 Main complain / duration
Severe pain after defecation for 5 days
 History of present illness
Sudden, increasing, always during & after defecation, lasts for hours, 8
out of 10 aggravated by defecating
 Associated symptoms
Constipation, bleeding per rectum (few drops)
 Past history
Chronic episodes of constipation.
 Family history
unremarkable
 Social History
Smoking
Examination
 Inspection
Perianally a fissure can be seen
 Palpation
Severe pain, cant be done
 Inspection
NA
Management
 Investigation:
---------
 Treatment:

Lifestyle modification: Increase fiber &

fluid intake, soaking in warm water for 10
.to 20 minutes
Medical: Topical nitroglycerin,
.metronidazole
:Lateral internal sphincterotomy Surgery
Case 3
A 65 years old male patient, presented to
your clinic with a main complaint of
.bleeding per rectum & fatigue
History
 Personal history
65 years, male.
 Main complain / duration
Bleeding per rectum for 2 years
 History of present illness
Bleeding per rectum, gradually, increasing, 1 to 2 times per day, bright red
in color, 2 towels ,bleeding at the time of defecation.
 Associated symptoms
Unintentional weight loss, fatigue, malaise & lethargy.
 Past history
patient is hypertensive & diabetic
 Family history
Father diagnosed with colorectal cancer at age 62
 Social History
smoker( ( since 30 years, 2 packs per day)
Examination
 Inspection
------------
 Palpation
May detect mass ?
 Inspection

.Blood, mucos
Management
 Investigation:
(Cbc for anemia)
Fecal immunochemical test (FIT)
Guaiac-based fecal occult blood test
(gFOBT)
Colonoscopy. (Best)

 Treatment:
Chemotherapy, immunotherapy, surgery
Colonoscopy
Case 4
year old male who presented to the 22
surgery department of a tertiary level
hospital having been referred from a
private clinic, with a two month history of
severe abdominal cramps, persistent
bloody and mucoid diarrhea, weight loss
.and tiredness
History
 Personal history
22 year, male.
 Main complain / duration
Bloody diarrhea for 2 months.
 History of present illness
bleeding per rectum with diarrhea started gradually, increased in
frequency,
 Associated symptoms
Abdominal pain.
 Past history
unremarkable
 Family history
His father is a known case of ulcerative colitis
 Social History
unremarkable
Management
 Investigation:
CBC for anemia
Colonoscopy
Abdominal X-Ray
(lead pipe appearance)
 Treatment:
Rehydration, antidiarrheal
5-ASA
Lead pipe appearance
Thank you