Summary of Common Conditions Seen in OSCEs
Hints and Tips for the Exam
Be Sensitive
Patients are often reluctant to discuss rectal bleeding as they see it as a topic that is both intimate to them as well as somewhat unpleasant to discuss. This is why it is important to spend some time putting the patient at ease, expressing empathy, exploring their ideas and concerns, and reassuring them that it is a common complaint and that you are used to seeing patients with it.
Type of Bleeding
This is fundamental to locating the site of the bleeding (see the table).
| Characteristics of rectal bleeding | Location of source of bleeding |
| Melaena | Colon proximal to terminal ileum |
| Red blood mixed with stool or coating stool | Colon distal to terminal ileum |
| Fresh red blood dripping separately from stool | Anus (e.g. fissure) or haemorrhoid |
Remember to Take a General Gastroenterological History
It can be easy to take a history that focuses on the anorectal area. Remember, however, that many serious causes of rectal bleeding (such as inflammatory bowel disease and colon cancer) could result in pathology elsewhere in the gastrointestinal tract, so it is important that you enquire about the entire gastroenterological system and any ‘red flags’ that may be unrelated to the presenting complaint (such as weight loss).
Questions You Could Be Asked
Q. Above which point in the gastrointestinal tract does bleeding cause melaena (as opposed to fresh red bleeding)?
A. Although there is no specific point immediately after which fresh red blood suddenly becomes melaena, generally speaking bleeding from an area proximal to the terminal ileum is more likely to be melaena, as there is scope for significant ‘digestion’ in that part of the gastrointestinal tract.
Q. How would you manage a bleeding haemorrhoid?
A. See the chapter text.
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