Write a description of the health history you would need to collect from the patient in the case study to which you were assigned.
In the assessment of rectal bleeding the physicians will have to assess the duration of bleeding, the nature of the bleeding as to whether it is fresh blood-streaked or mixed-blood with stool. Similarly, the physician will assess the patient in regard to anal pain or discomfort, itchiness or lumps (Treas & Wilkinson, 2014). On the other hand, a personal history of relate illnesses such as colorectal cancer, colorectal polyp, inflammatory bowel disease will be determined to ascertain any chances of the progression of the illness (Keir, et al., 2015). A family history of any of these illnesses or cases of rectal bleeding will also be important for the physician. Further, the physician will seek to know whether the patient can attest to any significant weight loss over prior to the current rectal belling issues or after the commencement of this problem. A lifestyle history of the patient in relation to use of alcohol will help determine the chances that chronic liver illnesses, portal hypertension and the associated hemorrhoids and varices which present in a similar way ((Keir, et al., 2015).
Explain what physical exams and diagnostic tests would be appropriate and how the results would be used to make a diagnosis.
Basically, digital rectal examination is the conventional method that can be used to ascertain the presence of blood ion the rectum and to eliminate the possibilities of rectal and pelvic masses. The full blood count (FBC) would be useful in determining the chances or probability of profound bleeding or presence of anemia (Keir, et al., 2015). This test would form the basis of studies iron and on Ferritinin the case where iron deficiency anemia is suspected. Colonoscopy is another examination which can help in tissue biopsy as well as removal in cases where malignancy has been detected or suspected. This can also be accomplished via the computed tomography (CT) colonography (Jarvis, 2015).
List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each.
Inflammatory bowel disease: The IBD causes and inflammation of the bowel and this could lead to erosion of tissues leading to internal bleeding within the bowel. During excretion, blood stains could be present in the stool (Keir, et al., 2015).
Diverticular Disease: this condition occurs in the colon/ lower gastrointestinal which causes hemorrhage as a result of the mucosa herniation. Due to the hemorrhage, blood stains could be visible in the stool (Stacey & Green, 2013).
Benign anorectal disease: When inflammation occurs within the rectum, the blood vessels in this region tend to become swollen these are referred to as Hemorrhoids. When these Hemorrhoids persist over time, the blood vessels will gradually wear out and blood spots will be visible in the stool and in the rectum region (Stacey & Green, 2013).
Colorectal Cancer: IN this case, there occurs malignant growth within the rectum and colon which are usually a progression of the polyps. Due to the inflammation caused by the malignant growth, the rectum and the mucosal tissue of the rectum and the colon tend to erode and thus exposing the lower tissues hence the presence of blood in stool (Stacey & Green, 2013).
Bowel (Colonic) Polyps: when there occurs a familial polyposis within the colon, there is an associated development or growth of adenomas within the rectum and colon which lead to inflammation of the tissues. Essentially, with the rectum inflamed, chanced of blood in the stool are high.
Jarvis, C. (2015). Physical examination & health assessment (7th ed.). St. Louis, MO: Saunders/Elsevier.
Keir, M., Cabanski, C., Zhao, R., Colombel, J. F., Panes, J., Lu, T., & Higgins, P. (2015). Rectal bleeding accurately reflects mucosal inflammation in patients with Ulcerative Colitis. In Journal of Crohns & Colitis(Vol. 9, pp. S137-S138). Elsevier Science BV.
Stacey, R., & Green, J. T. (2013). Nonendoscopic therapies for the management of radiation-induced rectal bleeding. Current opinion in supportive and palliative care, 7(2), 175-182.
Treas, L. S., & Wilkinson, J. M. (2014). Basic nursing: Concepts, skills, & reasoning. Philadelphia, PA: F.A. Davis Company.