Diagnosing upper abdominal pain with rectal bleeding presents a challenge to the physician. The two conditions may or may not be related, which requires both to be worked up separately. A thorough workup of these symptoms will be outlined here. A workup is a series of steps and diagnostic procedures done until the etiology is confirmed or all possibilities are ruled out.
Perform a complete history and physical exam of the patient. A thorough history is important to determine if there is any family history of the same symptoms or conditions. This may be helpful in determining any possibilities of the cause.
Perform a complete physical. Palpate the neck and groins to determine if any enlarged lymph nodes are present. Palpate the abdominal area, feeling for any masses and seeking to localize the site of the pain. Listen for bowel sounds with a stethoscope. Perform a visual and digital exam of the rectum.
Perform necessary laboratory tests. This will include routine hematology and urinalysis. Obtain and evaluate the results, paying special attention to the red blood cell (RBC) and Hematocrit (HMC) to determine the extent of the bleeding. If these are very low, the patient may need a blood transfusion. This will also determine the urgency of obtaining a diagnosis and appropriate treatment.
Perform an ultrasound imaging procedure of the abdominal cavity and its organs. Identify any abnormalities.
Perform a CT scan of the abdominal cavity to determine the presence of any abdominal masses or tumors. An enhanced CT with contrast may also be helpful in locating the exact source of the bleeding. Treatment to stop the bleeding may be prudent during the CT scan if is determined the source is a vascular abnormality. Using catheters the source can sometimes be embolized to stop the bleeding in certain cases.
Perform a complete colonoscopy to determine if the source of bleeding is in fact coming from the colon. If colonoscopy is negative an upper endoscopy should be performed.