Summary
Definition
History and exam
Key diagnostic factors
- intermittent abdominal pain
- abdominal distention
- nausea
- vomiting
- change in bowel habit
- presence of risk factors
- hard faeces
- soft stools
- empty rectum
- recent weight loss
- rectal bleeding
- palpable rectal mass
- palpable abdominal mass
- tympanic abdomen
- abnormal bowel sounds
- fever
- abdominal tenderness
- abdominal rigidity
Risk factors
- current or previous malignancy
- diverticular disease
- colonic volvulus
- current or previous hernia
- gynaecological conditions
- diabetes
- previous abdominal surgery
- megacolon
- laxative abuse
- previous radiotherapy
- diet
Diagnostic investigations
1st investigations to order
- computed tomography
- full blood count
- electrolytes
- C-reactive protein
- urea/creatinine ratio
- glucose
- clotting, group and save, or cross-match
- arterial blood gas (including lactate)
- serum amylase/lipase
Investigations to consider
- beta-human chorionic gonadotrophin
- urinalysis
- ultrasound
- water-soluble contrast study
- lower gastrointestinal endoscopy or flexible sigmoidoscopy
Treatment algorithm
Contributors
Expert advisers
Jennifer Straatman
Consultant Upper GI Surgeon
Queen Alexandra Hospital
Portsmouth
UK
Disclosures
JS declares that she has no competing interests.
Acknowledgements
BMJ Best Practice would like to gratefully acknowledge the previous team of expert contributors, whose work is retained in parts of the content:
George Malietzis, MBBS, MSc, MRCS
Colorectal Registrar
Department of Coloproctology
St Mark's Hospital
London
UK
John T. Jenkins, MD
Consultant Colorectal Surgeon
Department of Coloproctology
St. Mark's Hospital
London
UK
Disclosures
GM and JTJ declare that they have no competing interests.
Peer reviewers
Ceri Beaton, BMedsci, BMBS, MSc, FRCS
Consultant Colorectal and General Surgeon
North Devon Healthcare NHS Trust
Devon UK
Disclosures
CB declares that she has no competing interests.
Editors
Emma Quigley
Section Editor, BMJ Best Practice
Disclosures
EQ declares that she has no competing interests.
Tannaz Aliabadi-Oglesby
Lead Section Editor, BMJ Best Practice
Disclosures
TAO declares that she has no competing interests.
Sue Mayor
Lead Section Editor, BMJ Best Practice
Disclosures
SM works as a freelance medical journalist and editor, video editorial director and presenter, and communications trainer. In this capacity, she has been paid, and continues to be paid, by a wide range of organisations for providing these skills on a professional basis. These include: NHS organisations, including NICE, NHS Choices, NHS Kidney Care, and others; publishers and medical education companies, including the BMJ Group, the Lancet group, Medscape, and others; professional organisations, including the British Thoracic Oncology Group, the European Society for Medical Oncology, NCEPOD, and others; charities and patients’ organisations, including the Roy Castle Lung Cancer Foundation and others; pharmaceutical companies, including Bayer, Boehringer Ingelheim, Novartis, and others; and communications agencies, including Publicis, Red Healthcare, and others. She has no stock options or shares in any pharmaceutical or healthcare companies; however, she invests in a personal pension, which may invest in these types of companies. She is managing director of Susan Mayor Limited, the company name under which she provides medical writing and communications services.
Annabel Sidwell
Comorbidities Editor, BMJ Best Practice
Disclosures
AS declares that she has no competing interests.
Adam Mitchell
Drug Editor, BMJ Best Practice
Disclosures
AM declares that he has no competing interests.
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