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FINACS
Overview
Small bowel
Large bowel
The common causes of massive lower
GI-Bleeding are:
(a) Diverticular disease
(b) Angiodysplasia
(c) Aorto-enteric fistula
(a) Haemorrhoids
(b) Anal fissure
(c) Large bowel cancer
Surgical Pathology (Bleeding Per Rectum):
Diverticular haemorrhage
Angiodysplasia (Arteriovenous malformations)
Meckel’s diverticulum
Internal haemorrhoids
Anal fissure
History
Clinical Examination
Investigations
History:
Age of the patient
Nature of haemorrhage:
Colour
Clots
Drip with defecation
Smear on paper
Profuse loss
Mixed with stool
Perineal pain
Abdominal pain
Prolapse
Diarrhoea
Alteration in the bowel habit
Abdominal distension
Symptoms of anemia
Miscellaneous symptoms:
Weight loss
Disturbance of micturation
Family history
Clinical Examination:
Abdominal Examination:
- Abdominal mass, Distension
Anorectal Examination:
- Position of the patient left lateral with hips
and knee flexed and the buttocks over the
edge of examination couch.
- Inspection
- Patient straining
- Palpation (Digital examination)
- Proctoscopy
- Sigmoidoscopy (Rigid)
- Colonoscopy
Special Investigations:
CT Scan
Selective angiography
Isotope studies
Barium enema
Name:_______________________ Date:_____________________________
Weight:______________________ BP:_______________________________
LOS:_________________________ Past RX:___________________________
CC:__________________________ Family Hx:_________________________
ROS:________________________________________________________________________
Bleeding:________________________ Pain:_______________________________
Irritation/Itching:__________________ Swelling:____________________________
Constipation:_____________________ Diarrhea:____________________________
Time on Commode:_________________ Straining:____________________________
OTC RX:__________________________ RX:_________________________________
Abdomen:______________________ Heart:____________________________
Fissure:_________________________ Sentinel Pile:_________________________
Ext Hem:__________________________________ Skin :___________________________
Int Hem: LL___ RA___ RP___ Spasm:_____________________________
Proctosigmoidoscopy;_________________________________________________________
Anoscopy:__________________________________________________________________
Anal Fissure
Complete Rectal Prolapse-
Procidentia
Anal Cancer
Hypertrophic Anal Papillae
Colorectal Polyp
Rectal Villous Adenoma
Colorectal Cancer
Rectal Cancer
Inflammatory Bowel Disease
Beginning at age 50 (45 for African Americans), men and women who are at
average risk for developing colorectal cancer should have 1 of the 5 screening
options below:
a fecal occult blood test (FOBT)* or fecal immunochemical test (iFOBT or
FIT)* every year**, OR
flexible sigmoidoscopy every 5 years, OR
an FOBT* or FIT* every year plus flexible sigmoidoscopy every 5 years**, OR
(Of these first 3 options, the combination of FOBT or FIT every year plus
flexible sigmoidoscopy every 5 years is preferable.)
double-contrast barium enema every 5 years**, OR
colonoscopy every 10 years
*For FOBT or FIT, the take-home multiple sample method should be used.
**Colonoscopy should be done if the FOBT or FIT shows blood in the stool, if
sigmoidoscopy results show a polyp, or if double-contrast barium enema
studies show anything abnormal. If possible, polyps should be removed
during the colonoscopy.
CT Colonography
1. Helical CT scan creates two and three-dimensional images.
Prepare with phospha-soda and bisacodyl. Air insufflation.
2. Accurate in detection of polyps greater than 10 mm and colon
cancer.
3. False positives 15% unnecessary colonoscopy from retained
stool, diverticular disease, thick or complex haustral folds,
metal or motion artifacts.
4. May miss flat adenomas which are more aggressive.
5. Non therapeutic.
6. More expensive and not covered by insurance.
Fissure
Skin tags
Skin tags are extra folds of skin around the anal verge.
Caused by stretching of skin from dilated external
hemorrhoids. May interfere with cleaning and add to
pruritus ani. Cosmetic issue to some.
Skin tag and can be removed or left alone depending on
preference.
Removal requires local anesthesia and office excision.
Takes 15 minutes and leads to 2-3 days of discomfort.
Associated skin tags