Rectal Bleeding / Positive FOBT

This condition is treated in the Gastroenterology clinic.

Pre-referral work-up

History

All referrals should comply with the referral standards and include in particular:

• Duration of symptoms
• Reason for doing FOBT- screening? (NBCSP) If the patient has a positive National Bowel Cancer Screening Service Result, please indicate this clearly on referral
• Weight loss, abdominal pain or other symptoms
• Blood mixed in with stool
• If the patient is taking hypoglycaemic agents, anticoagulants of any sort or iron supplements. Please indicate this and the reason for their use.
• Pathology results, Essential: FOBT result, FBE, Iron Studies and consider B12
• BMI (or height & weight)
• Please provide other information if present such as, morbid obesity, inability to read or understand English, likely inability to self-manage colonic preparation.
• If possible please complete the PR Bleeding Patient Questionnaire and include with your referral. This questionnaire can be downloaded as a PDF version or using the PHT referral template which you can download into your practice software.

Tests

Pathology:

FBC

iron studies

U&E

Imaging:

Any relevant

Investigations:

Rectal examination result

Interim/GP management

To refer a patient with this condition, please see the Gastroenterology clinic page for the full referral process and templates.

Also look at general surgery and colorectal surgery guidelines

For more information please see the HealthPathways Tasmania website.

Clinic appointments

? Red location flags are clinical indicators of possible serious underlying conditions requiring further medical intervention. They may or may not indicate an emergency.

Emergency

? Potentially life-threatening symptoms suggestive of:

• acute upper GI tract bleeding
• acute severe lower GI tract bleeding
• oesophageal foreign bodies/food bolus
• bowel obstruction
• abdominal sepsis
• Acute Severe Colitis - see note

? Severe vomiting and/or diarrhoea with dehydration
? Acute/fulminant liver failure (to be referred to a centre with dedicated hepatology services
? Biliary sepsis (to be referred to a centre with ERCP service)

Note:Acute severe colitis as defined by the Truelove and Witts criteria - all patients with greater than or equal to 6 bloody bowel motions per 24 hours plus at least one of the following:

• temperature at presentation of over 37.8°C,
• pulse rate at presentation of over 90 bpm,

haemoglobin at presentation of under 105 gm/l, CRP over 30mg/dl at presentation (or ESR over 30 mm/hr)

If you, or someone else, are experiencing a serious and life-threatening injury or illness call triple zero (000) immediately or go to the nearest Emergency Department.

Learn more about when to access emergency care and non-emergency care options if the injury or illness is not serious or life-threatening.

Urgent (Category 1)

Rectal bleeding with any of the following concerning features :

• dark blood coating or mixed with stool
• weight loss, greater than or equal to5% of body weight in previous 6 months
• abdominal / rectal mass
• iron deficiency in males and postmenopausal women or unexplained iron deficiency in premenopausal women
• patient and family history of bowel cancer (1st degree relative under 55 years old)

We will endeavour to see these patients within four weeks

Urgent referrals should be accompanied by a phone call to the clinic and the relevant doctor for urgent assessment, or patient should be directed immediately to the Emergency Department.

Semi-urgent (Category 2)

Rectal bleeding without concerning features(as above)

Availability

North

Launceston General Hospital
Level 3 - Specialist Clinics

Phone: 1300 977 694
Fax: 03 6777 5227

North West

All North West referrals are managed via  Mersey Community Hospital
Phone: 03 6478 5222
Fax: 03 6441 5942

South

Wellington Clinics (Level 10)
Phone: 03 6166 0000
Fax: 03 6234 3982