Rectal Bleeding History Taking | OSCE Tips

Rectal bleeding, history taking is a crucial skill that is frequently tested in OSCEs. This tutorial offers a methodical way to collect a rectal bleeding history during an OSCE.

Presenting complaint (PC): 

What brought you here today? 

Can you tell me more about the bleeding?

History presenting complaint (HPC):

You can adapt SOCRATES to explore skin problems too: Site, Onset, Character, Radiation, Associations, Time course, Exacerbating/Relieving factors and Severity.

Site: n/a

Onset: when did you first notice the rectal bleeding? suddenly or gradually?

Character: can describe the blood (e.g. bright red / dark / mixed with stools)

Radiation: n/a

Associate symptoms:

• Any change in your bowel habbit?

• Any abdominal pain?

• Any weight loss?

Timing: are the symptoms getting worse or better?

Exacerbating/Relieving factors: does anything make it better or worse?

Severity: from a scale from 1 to 10. with 10 being the worse, how severe is the bleeding?

Ideas, Concerns & Expectations (ICE): 

Now is a good idea to ask Ideas, Concerns & Expectations (ICE): do you have an idea what might be causing your symptoms? is there anything that particularly concern you? what were expecting to achieve in this consultation?

Past medical history (PMH): 

Ask about any previous episodes of rectal bleeding issues or treatment or investigations?

Drug history (DH):

Are you taking any medication (prescribed or over-the-counter (OTC)? If so, any side effects.

Any recent use of medications that might have caused a reaction? (NSAIDs are known to cause rectal bleeding)

Allergies:

Are you allergic to any medications?

Family history (FMH): 

Is there any family members who have similar symptoms? 

Social History (SH): 

Ask about living condition, occupation and social support.

Do you smoker? alcohol? recreational drug use?

System review: 

Review each body system to check for any other symptoms that might be causing the bleeding.

Possible differential diagnosis:

1. Haemorrhoids (piles)

2. Anal fissure

3. Rectal prolapse

4. Diverticular disease

5. Cancer

Summaries your findings.

Investigation: 

• Digital Rectal Exam (DRE)

• Stool test ( Faecal Calprotectin, Faecal Immunochemical Test)

• Bloods: full blood count (FBC), C-reactive protein (CRP) + Erythrocyte Sedimentation Rate (ESR), coagulation profile.

• Colonoscopy.

• CT Scan.

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