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Case Study Of Patient With Rectal Bleeding

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As per the case study Mrs. White was released from the medical facility due to the massive surge of covid-19 pandemic. But the medical professionals maintained constant telephonic consultation with her. She upon consultation reported that she is bloating and a constant persistence of pain in the lower abdomen. She also reported that she is experiencing nausea but no vomiting. She also reported that she is suffering from loss of appetite and a stable weight loss. She also informed the telephone consultant that she suffered from covid-19 during April. She is also on her hypertension and depression medication. She stated that she has seen a considerable amount of blood in the stool. So by accounting her condition the doctor recommended having a check up to find out whether she's affected with rectal cancer.


Impact Of Advanced Clinical Practice

This case study of the huge impact on advanced clinical practice. Upon the preliminary understanding the doctor recommended having a proper diagnosis regarding the presence of rectal cancer (Rodriguez-Justo et al., 2019). According to the guidelines issued by the NHS the disease which has greater susceptibility to become fetal in nature must be eliminated or diagnosed first. Apart from this the symptoms shown by Mrs white are quite well aligned with the symptoms of rectal cancer. This kind of approach is highly important to save some crucial time for the patient who is suffering from any life threatening disease.

The Key Concepts Involved In Advanced Clinical Reasoning And Decision Making

The clinical reasoning or decision making process is quite complex and must be well aligned with the guidelines issued by the government or other such governmental agencies. The medical facility firstly rules out the possibility of having life straightening disease which requires proper timely interventions such as carcinoma (Mowat et al., 2020). For this reason the Endoscopist recommended diagnosing any presence of carcinoma tissue in the rectal walls. The symptoms like abnormal weight loss associated with presence of blood in the stool can be taken as well noted evidence to have a proper diagnosis is adding the presence of Cancer tissue.

Other than these the patient may suffer from presence of hemorrhoids in the rectal wall. So it must be diagnosed if it is found that there is absence of any carcinoma cells in the rectal walls.

Critical Analysis Of The Clinical Endoscopist Role

The endoscopist performs a great role in this procedure. He works under the guidance of the NHS to improve the standard of service that he is providing. According to the guidelines the endoscopies have the full authority to prioritise the cases according to their complexity. In the case of Mrs white endoscopist played a great role in order to provide primary diagnosis by analysing the tissues in the rectal wall to see any presence of carcinoma in it (Quigley et al., 2018). As mentioned before it is quite under the rule of the NHS that endoscopists have to diagnose the presence of any life treating diseases.

So from the preliminary analysis it will be very safe to justify that the person who was in charge of performing endoscopy has done his job quite well according to the rule and regulation as well as the ethical consideration of the medical profession.

Endoscopic Findings Based

  • Anatomy

Mrs white is a 75 year old woman who has suffered from covid-19. So it can be said that her immune system is quite sufficient. Other than this there are few complexities that come along with age (Ford et al., 2017). According to the NHS the risk of developing rectal carcinoma increased as per the age. Apart from having cancer there are also chances of developing diverticulitis or hemorrhoids in the rectal wall. This may also result in abnormal rectal bleeding.

  • Medical History

The medical history of an individual dolphin plays a great role in the process of developing diseases. Mrs white just recovered from covid-19 which signifies that she is in an highly immuno compressed state. She also has a history of bleeding. Recently she also stated that there is a change in the bowel habit accompanied by acute constipation and abdominal pain. These whole signs and symptoms can be considered as the primary symptoms of having rectal cancer.

  • Lower Gastrointestinal Tract

By the help of the endoscopy the medical team can get proper imaging of the internal wall of the rectal canal. This can be quite helpful in order to have an idea regarding the carcinoma cells and other complexities in the rectal wall. As per the case study of the patient there is a presence of blood in the stool of the patient (Edwards et al., 2020). This signifies that the rectal wall is bruised and may contain some hemorrhoids in it.

Differential Diagnosis

Other than having carcinoma in the rectal walls Mrs white can suffer from hemorrhoids. It is often seen that the individual at their late 70 having hypertension can develop clotting of blood in the rectal walls (Arikan et al., 2018). As per the case study Mrs white also suffers from hypertension and on constant medication. Other than these the hemorrhoid can also cause bleeding in the stool. So the medical professionals other than searching for carcinoma cells also identify the presence of hemorrhoids in the rectal walls.

Recommend Further Investigations

The usage of "ultrasonography" can also be a proper investigation option for the medical personnel. If it is seen that there is no prevalence of carcinoma or hemorrhage in the rectal walls there may be some sort of infection in the internal organs which are causing bleeding in the stool.

Evidence-based Management Plan And Holistic Care

As per the recommendation of the NHS and "World health organisation" the process of endoscopy has been done with extreme care. Previously It is seen that during the process of endoscopy there is unusual bleeding (Shields et al., 2017). So in order to avoid this kind of scenario endoscopists have provided Mrs white with anticoagulants. This can cause any further hemorrhoids in the rectal walls.


As per the case study the process of endoscopy to detect the presence of carcinoma cells in the rectal walls was a a good move. Presence of carcinoma in the rectal walls with respect of the age of the patient can have a fatal outcome. Other than this it must be recommended that the medical professional must try to detect the presence of hemorrhoids In The rectal Wall as it can sometimes have similar kinds of symptoms. All the legal as well as the ethical procedure for the diagnosis of the disease have been performed with care. So it can be said that the medical professionals have provided the proper primary intervention on time.

Reference list


Banks, M., Graham, D., Jansen, M., Gotoda, T., Coda, S., Di Pietro, M., Uedo, N., Bhandari, P., Pritchard, D.M., Kuipers, E.J. and Rodriguez-Justo, M., 2019. British Society of Gastroenterology guidelines on the diagnosis and management of patients at risk of gastric adenocarcinoma. Gut68(9), pp.1545-1575.

Digby, J., Strachan, J.A., McCann, R., Steele, R.J., Fraser, C.G. and Mowat, C., 2020. Measurement of faecal haemoglobin with a faecal immunochemical test can assist in defining which patients attending primary care with rectal bleeding require urgent referral. Annals of Clinical Biochemistry57(4), pp.325-327.

Ford, A.C., Moayyedi, P., Chey, W.D., Harris, L.A., Lacy, B.E., Saito, Y.A. and Quigley, E.M., 2018. American College of Gastroenterology monograph on management of irritable bowel syndrome. Official journal of the American College of Gastroenterology| ACG113, pp.1-18.

Hunt, R., Armstrong, D., Katelaris, P., Afihene, M., Bane, A., Bhatia, S., Chen, M.H., Choi, M.G., Melo, A.C., Fock, K.M. and Ford, A., 2017. World gastroenterology organisation global guidelines: GERD global perspective on gastroesophageal reflux disease. Journal of clinical gastroenterology51(6), pp.467-478.

Kennedy, N.A., Jones, G.R., Lamb, C.A., Appleby, R., Arnott, I., Beattie, R.M., Bloom, S., Brooks, A.J., Cooney, R., Dart, R.J. and Edwards, C., 2020. British Society of Gastroenterology guidance for management of inflammatory bowel disease during the COVID-19 pandemic. Gut69(6), pp.984-990.

Ozsoy, M., Ozsoy, Z., Sahin, S. and Arikan, Y., 2018. An alternative technique in the control of massive presacral rectal bleeding: fixation of GORE-TEX® aortic patch. Nigerian Journal of Surgery24(1), pp.60-62.

Weingart, S.N., Stoffel, E.M., Chung, D.C., Sequist, T.D., Lederman, R.I., Pelletier, S.R. and Shields, H.M., 2017. Delayed workup of rectal bleeding in adult primary care: examining process-of-care failures. The Joint Commission Journal on Quality and Patient Safety43(1), pp.32-40.

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