Intern Report Presentation 2.10


Presented by Brandon Cheppa, MD

Chief Complaint:  Bleeding per rectum

HPI:  5-year-old is brought in by his mother because of blood in his stool.  She noticed it earlier this morning after her son had a bowel movement.  The blood is bright red and streaked along the side of his feces, which are hard and brown.  He is passing less stool than usual, having 1 bowel movement per day instead of 3.  He has a “burning” anal pain every time he has a bowel movement.  The patient does not want to eat because he is afraid to have a bowel movement, and he displays a posture to avoid putting weight on his buttocks.  He denies any fever, vomiting, diarrhea, trauma, or any similar prior history.

ROS:  As per HPI
PMH: None
PSH: None
Meds: None
Immunizations: Up to date
Family History: None
Social History: None

Examination of organ systems and body areas:

Vitals:  HR: 84 RR: 18  T: 37.1 (Temporal)
General:  Patient is active, playful, smiling, appearing well-hydrated.  He is standing and anxious about anyone touching him.
Head:  Normal scalp.
Ears:  Normal tympanic membranes.
Eyes:  Normal eyes.  Normal conjunctivae.
Nose:  Moist mucous membranes.
Neck:  Supple.  No lymphadenopathy.
Chest: Good air entry bilaterally.  No added sounds.  No retractions, or wheezing.
Cardiovascular:  Good peripheral pulses.  Normal heart sounds.
Abdomen:  Flat, soft, nontender, Bowel sounds positive.  No organomegaly.
Extremities: Nontender.  No bruising.  No swelling.  Normal tone.
Skin: No rash.
Neurologic:  Normal reflexes.  No meningeal signs.
Genitourinary:  External genitalia, normal male genitalia.  Bilateral descended testes.  No hernia.
Rectal:  An examination shows a fissure at 12 o’clock and 7 o’clock.  There was hard stool in the vault and the stool was guaiac negative.  The anus was tender on digital exam.

Guaiac Negative




1.  When is an anal fissure considered chronic?
A.  2 weeks
B.  4 weeks
C.  6 weeks
D.  8 weeks
E.  10 weeks

2.  Where is the most common location for an anal fissure in both males and females regardless of age?

A.  anterior midline
B.  anterior-lateral area
C.  lateral line
D.  posterior midline
E.  posterior-lateral area

3.  What is the most common cause of rectal bleeding in infancy?
A.  anal fissure
B.  infectious diarrhea
C.  intussusception
D.  Meckel’s diverticulum
E.  polyp

Please submit your answers to the questions in the “leave a reply” box or click on the “comments” link.  Your submission will not immediately post.  Answers with a case discussion will post on Friday.  If you have any difficulty, please contact the site administrator at Thank you for participating in Receiving’s: Intern Report.

3 Responses

  1. 1. c
    2. d
    3. e

  2. BDA

  3. 1. C
    2. D
    3. A

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