Transcription - 20250721T 16-24.mp3

So by the late afternoon I'm feeling better okay fine and how long have been feeling poorly in the morning for about 3 or 4 days okay and anything else no fine your gp note mentioned that you had some dark stools oh yes from ongoing light yeah it's right tell me about that and blood blood yes alright so dark red stools or bright red you could say that yes because you can't actually see it because it's all mixed mixed yeah I see but there was a couple of occasions when after a bean saloon when I looked in the pan it was like if you had upset a jar of beetroot it was that really that kind of pulp yeah yeah to tinge the water yes but you didn't necessarily see it massively in the stool what what color is the poo is very very very hemoglobin 79 from 94 with platelets 131 from a 150 previously hemoglobin a 139 back in july 2024 euthanese normal crp normal in november euthanese today normal iron arm 0.9 impression lower gi bleeding it's likely colonic angiodysplasia on examination chest clear heart sounds normal no adjacent systolic murmur abdomen soft and nontender <\n\n> Investigations ogd october 2024 small gastric diverticulum but no other abnormalities seen ct tap no cause for hemoglobin drop or radiological evidence of malignancy 1 transfuse 1 unit of packed red blood cells number 2 refer to surgical assessment unit for admission number 3 to consider 2 week wait colonoscopy on discharge to investigate cause + or - treat lower gi bleeding

Presenting Complaint:
Lower gastrointestinal bleeding

Past Medical History:
• Not documented

Diagnosis:
Lower gastrointestinal bleeding, likely colonic angiodysplasia

I had the pleasure of meeting this patient in Same Day Emergency Care today.

The patient presented with a 3-4 day history of feeling unwell in the mornings, improving by late afternoon. They reported dark stools with episodes of bright red blood mixed in, describing the toilet water as appearing like "upset beetroot" after defaecation. The bleeding was not always visible in the stool itself but was evident in the toilet bowl.

On examination, chest was clear with normal heart sounds and no adjacent systolic murmur. Abdomen was soft and non-tender.

Blood results showed a significant drop in haemoglobin from 94 to 79 g/L, with platelets falling from 150 to 131. Previous haemoglobin in July 2024 was 139 g/L. CRP was normal and iron studies showed iron of 0.9.

Investigations:
OGD October 2024: Small gastric diverticulum, no other abnormalities
CT TAP: No cause for haemoglobin drop identified, no radiological evidence of malignancy
FBC: Haemoglobin 79 g/L (down from 94), platelets 131 (down from 150)
Iron studies: Iron 0.9
CRP: Normal

Plan:
1. Transfuse 1 unit of packed red blood cells
2. Refer to Surgical Assessment Unit for admission
3. Consider 2-week wait colonoscopy on discharge to investigate and potentially treat lower GI bleeding

Summary

Investigations

Plans