From the Guidelines
For a 71-year-old female patient with rectal bleeding, I recommend performing an in-office evaluation including digital rectal examination and anoscopy to assess for common causes like hemorrhoids or anal fissures, as suggested by the most recent guidelines 1. This approach is based on the latest evidence from the World Journal of Emergency Surgery, which emphasizes the importance of a thorough physical examination, including a digital rectal examination, to rule out other causes of lower gastrointestinal bleeding 1. The patient's history of not being on aspirin therapy and the recent onset of bright red blood per rectum suggests that the bleeding may be due to a common anorectal condition such as hemorrhoids. Key steps in the evaluation and management of this patient include:
- Performing a complete physical examination, including a digital rectal examination, to assess for signs of bleeding and to rule out other causes of lower gastrointestinal bleeding 1
- Obtaining a complete blood count to evaluate for anemia and checking vital signs for hemodynamic stability 1
- Considering topical treatments such as hydrocortisone cream for hemorrhoids if identified 1
- Recommending a high-fiber diet, increased fluid intake, and stool softeners like docusate sodium to reduce straining 1
- Instructing the patient to monitor the frequency and volume of bleeding and to seek immediate medical attention if bleeding increases, she develops dizziness, or passes large clots 1 It is also important to note that the patient should be referred to a GI specialist for further evaluation and management, as the cause of the bleeding may be more complex and require specialized care 1.
From the Research
Patient Presentation
- The patient is a 71-year-old female with recent rectal bleeding, presenting with bright red blood from the rectum over the last few days.
- She is not on aspirin therapy and has not received therapy for 12 months.
Diagnostic Considerations
- Rectal bleeding can be caused by various conditions, ranging from benign to life-threatening 2.
- The patient's age and symptoms suggest the need for further evaluation to rule out colorectal cancer or other serious conditions 3, 4.
- A systematic approach to diagnosis, including history, examination, and investigation, is essential to determine the underlying cause of rectal bleeding 3.
Management Options
- Colonoscopy is recommended for patients over 40 years old presenting with rectal bleeding to screen for and treat premalignant polyps and colorectal cancer 3, 4.
- The decision to order a colonoscopy should be based on the patient's risk factors, age, and clinical presentation 4.
- Other diagnostic tests, such as laboratory results and imaging studies, may also be considered to evaluate the patient's condition 2.
Next Steps
- Consider ordering a colonoscopy for the patient, given her age and symptoms 3, 4.
- Evaluate the patient's risk factors for colorectal cancer and document them in her chart 4.
- Develop a plan for further evaluation and management based on the patient's clinical presentation and diagnostic test results 2.