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Rectal Bleeding (cont.)

Rectal Bleeding Diagnosis

A physical examination will be performed by the physician. If necessary, diagnostic tests may be ordered.

Physical exam: The focus is on finding the source and extent of bleeding. Priority is to identify significant low blood volume and begin appropriate treatment. This is the most life-threatening situation. The physician will focus on three aspects:

  1. Vital signs: Low blood pressure and elevated heart rate will indicate significant loss of blood. An elevated temperature will suggest infection.
  2. Abdominal examination: The physician will search for abdominal distension, discomfort, or tenderness that may suggest a possible bleeding ulcer. A mass the doctor can feel is cause for concern about cancer.
  3. Anal and digital rectal examination: The anus will be inspected for possible external sources of bleeding such as trauma, foreign body, or hemorrhoids. A finger examination is performed to assess tenderness, character of stool, and the presence of masses.

Diagnostic tests: Depending on the type and severity of bleeding, special tests may be performed to aid in diagnosis.

  • Blood tests: Blood samples are taken to assess the extent of blood loss, the clotting ability of blood, and the possibility of infection.
  • Nasogastric tube: A flexible tube is passed through the nose into the stomach to check for the presence of active bleeding. This may be uncomfortable, but can be a vital diagnostic test.

Scope examinations:

  • Anoscopy: A plastic or metal scope placed into the anus allows for quick examination of the rectal vault.
  • Flexible sigmoidoscopy: A flexible tube inserted into the rectum is used to evaluate the rectum and lower end of the colon.
  • Colonoscopy: A soft tube equipped with a light and camera is inserted into the rectum and pushed into the colon. The entire large colon is visualized. It is used to locate areas of bleeding, masses, or irregularities.
  • Barium enema X-ray: This study uses liquid barium inserted into the rectum. An X-ray is taken to highlight problem areas such as tumors or diverticula. However, sites of active bleeding cannot be distinguished.
  • Nuclear medicine studies: A tagged red blood cell scan may be used to pinpoint areas of slow bleeding.
  • CT scan: May be used to diagnose diverticulitis or tumors in the bowel.
  • Angiography: A contrast dye study is used to evaluate active areas of brisk bleeding.
Medically Reviewed by a Doctor on 11/13/2014
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