Symptoms

Bleeding PR

Altered bowel habits : frequency, quantity, consistency

Constipation : reduced frequency, quantity and increased consistency

Need to investigate after 6 weeks of persistent symptoms.

Chronic Constipation : less than 3 bowel movements per week and all 4 laxatives have failed (Osmotic:lactulose, Bulking : Fibrous, Softner : Cremaffin, Autonomic : Dulcolax)

Anaemia

Unexplained weight loss

Lower ab pain more than 6 weeks

Mass

Acute anus

Fissure

Thrombosed prolapsed haemorrhoids

Haematomas

Foreign body

Family hx of Breast Bowel and Cancers

FAP

HNPCC

Peutz

Villous adenoma (polyp) definitely malignant

When breach the basement memebrane : adenocarcinoma

Social Hx

Unskilled worker with mutiple dependants

SAD habits (Smoking, Alcohol, Drugs)

Fitness for Sx

Aerobic respiratory capacity

Abdomen examination

Soft not tender

Masses

Free fluid

Distension

Investigations

Diagnosis

Cause

Complications

Co-morbidities and Fitness

• Endoscopy
• Radiology
• Micro
• Biochem
• Histo
• Haemat