NHG-standaard (Geneeskunde): Bloedverlies rectaal - M89

Anamnese

Tijdens de anamnese bij rectaal bloedverlies moet gevraagd worden naar de duur en hoeveelheid van de ontlasting, maar ook naar een verandering in het defecatiepatroon, (peri)anale klachten, veel aandrang, koorts, buikpijn, malaise en onverklaard gewichtsverlies. Verder moet goed gevraagd worden naar de voorgeschiedenis, de familieanamnese, medicatie en naar de seksuele gewoonten.

Aanvullend onderzoek

Het aanvullend onderzoek bij rectaal bloedverlies bestaat uit het meten van de hemoglobine bij verdenking op anemie. BSE, CRP, Hb, leukocyten, trombocyten en albumine moeten gemeten worden bij een vermoeiden op een inflammatoire darmziekte. Wanneer tenslotte het vermoeden bestaat op colorectaal carcinoom moet een colonoscopie uitgevoerd worden en eventueel een sigmoïdoscopie.

Behandeling

De behandeling bij rectaal bloedverlies bestaat allereerst uit het advies voor een vezelrijke voeding, voldoende vochttoediening en er moet aangeleerd worden dat toegegeven wordt aan de defecatiereflex. De medicamenteuze behandeling bestaat uit laxeren en eventuele lokale middelen tegen hemorroïden of fissura ani, zoals vaseline.

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