A young office executive, on tour, presents with bright red painless bleed since 7 days and abdominal pain. External and perrectal examinations are normal. As attending general practioner what will be your next step:
proctoscopy
do a barium enema
refer to surgeon for sigmoidoscopy
refer to gastroenterologist for colonoscopy
Proctoscopy Hemorrhoids is most likely the cause of fresh, painless bleed in this young patient. (Other causes of fresh lower GI bleed are- fissures, diveicula, ischemic colitis, and aerio-venous malformations). So the next step would be to check for hemorrhoids using a proctoscope, before going for more invasive procedures like sigmoidoscopy or colonoscopy to diagnose other conditions.