A jaundiced, 43 year old alcoholic male presents to the emergency room complaining of bright red blood in his last two stools. He denies pain on defecation or changes in his bowel habits. Which of the following would be the most likely finding on sigmoidoscopic examination?
The patient's jaundice indicates that he has significant alcoholic liver disease. Hepatic fibrosis or cirrhosis both produce vascular injury and poal hypeension, which leads to the development of poosystemic shunts-most typically causing esophageal varices, caput medusae, and hemorrhoids. Bright red blood in stools is a classic presentation of hemorrhoids. Colorectal carcinoma generally develops in an older population, and produces occult blood loss rather than frankly bloody stools. Although diveiculosis may be an asymptomatic condition, diveiculitis is associated with significant abdominal distress, which may be accompanied by blood loss and diarrhea and/or constipation. Hyperplastic polyps are asymptomatic, non-neoplastic, polypoid growths, generally less than 5mm in diameter. They do not produce bleeding or any increased risk of carcinoma. Ref: Bullard Dunn K.M., Rothenberger D.A. (2010). Chapter 29. Colon, Rectum, and Anus. In F.C. Brunicardi, D.K. Andersen, T.R. Billiar, D.L. Dunn, J.G. Hunter, J.B. Matthews, R.E. Pollock (Eds), Schwaz's Principles of Surgery, 9e.
Colorectal carcinoma
Diveiculitis
Hemorrhoids
Hyperplastic polyps