Gastroenterology
Case 11: A Man with Rectal Bleeding
CASE
An 82‐year‐old man is admitted with rectal bleeding. He had felt well earlier in the day. After his evening meal he experienced a sudden urge to have his bowels open with some cramping lower abdominal discomfort. He experienced a single episode of passing clotted blood. During this period he felt quite light‐headed. Examination demonstrates a mild tachycardia (pulse 98 beats/min) but a normal lying blood pressure. Abdominal examination reveals no masses, nor areas of localized tenderness. Rectal examination shows some altered blood on the gloved examination finger. Rigid sigmoidoscopy to 15 cm reveals altered blood in the lumen of the bowel only.
Blood tests showed:
Hb 12.2 g/dL MCV 86 fL WCC 5.6 × 109/L Platelets 376 × 109/L Na 138 mmol/L K 4.2 mmol/L Urea 4.2 mmol/L Creatinine 86 µmol/L Albumin 40 g/L Bilirubin 12 µmol/L ALP 156 U/L ALT 26 U/L
QUESTION 1
Your score this session: 0 of 0
His blood test results are best explained by: