Rectal Bleeding / Positive FOBT

Availability

North South North West Statewide

Pre-referral work-up

History

All referrals should comply to 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. Please indicate this and the reason for their use.
  • 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 fax 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

Initial work up:

  • FBE
  • Rectal examination
  • Consider depending on co-moribidities
    • LFT, Creatinine and electrolytes including eGFR
    • Recent INR
    • Recent HBA1C (to indicate stability of diabetes if present)

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 Tasmanian Health Pathways website.

Urgent / category 1

Blood mixed in with stool

Anaemia

Pain

Weight loss

Abdominal mass

Iron deficiency anaemia

Semi-urgent / category 2

Change in bowel habit (To looser stools and/or increased frequency of defecation persistent for 6 weeks)

High risk family history (1st degree relative < 50 years of age at onset of colorectal cancer OR more than one 1st  degree relative with colorectal cancer)

Unexplained or recurrent rectal bleeding

Positive FOBT

Routine / category 3

< 40 years of age   with chronic haemorrhoidal type bleeding (no change in pattern)

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

Emergency:

Proceed to Emergency Department (ED). Please contact ED Medical Officer in Charge:
LGH ED – Phone: (03) 6777 6405  Fax: (03) 6348 7382
MCH ED – Phone: (03) 6478 5120  Fax: (03) 6426 5115
NWRH ED – Phone: (03) 6493 6340  Fax: (03) 6430 6691
RHH ED - Phone: (03) 6166 6100  Fax: (03) 6222 8919

Urgent:

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:

We will endeavour to see these patients within 12 weeks

Routine:

Next available appointment