Gastroenterology
Case 3: A Man with a History of Constipation
CASE
A 68‐year‐old man presents with a 4‐month history of constipation. He is having his bowels opened no more than once every week passing an uncomfortably firm stool. On one or two occasions he has experienced bright red rectal bleeding, mainly visible on the toilet paper. He has lost 6 kg in weight. Examination shows him to be dehydrated with dry mucous membranes and a postural blood pressure drop. Examination of the abdomen including digital examination of the rectum is normal. Abdominal X‐ray demonstrates constipation but shows no evidence of obstruction. Chest X‐ray is normal.
Blood tests showed:
Hb 14.8 g/dL WCC 6.4 × 109/L Platelets 272 × 109/L Plasma viscosity 1.68 cP Na 135 mmol/L K 4.5 mmol/L Corrected Ca 3.24 mmol/L Urea 18.4 mmol/L Creatinine 186 µmol/L
QUESTION 1
Your score this session: 0 of 0
In view of the history of bleeding he ought to undergo: