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Hemoccult Positive Stool
Diagnosis/Definition
- Occult bleeding (i.e., no melena or hematochezia) detected by the use of fecal occult blood testing cards (Hemoccult, Fecult).
- FOBT – Fecal occult blood test.
Initial Diagnosis and Management
- Positive stool card on any one of 3 spontaneously passed, consecutive bowel movements with patient on a dietary protocol.
- Should not be done in course of a routine rectal (digital) examination if assessing truly for occult bleeding.
Ongoing Management and Objectives
- Minimum evaluation should be of the entire lower GI tract
- In patients with gastrointestinal symptoms, a more extensive evaluation may be warranted.
- Colonoscopy is the preferred test; alternatively, flexible sigmoidoscopy with an air contrast barium enema can be considered in patients who meet all these criteria: <65, asymptomatic, not anemic, no family history of colon cancer, no family history of adenomatous polyps. (If on the flexible sigmoidoscopy, diverticuli or polyps are noted, DO NOT do a barium enema but refer the patient for colonoscopy).
Indications for Specialty Care Referral
Patients who meet any one of these criteria: > 65, unexplained anemia or iron deficiency anemia, symptoms worrisome for colonic disease/carcinoma, prior history of colonic adenomas or carcinoma, family history of colon cancer.
Patients whose flexible sigmoidoscopy reveals adenomatous polyps, carcinoma or diverticular disease.
Patients with an abnormal barium enema.
Patients with prior FOBT positive evaluations done with flexible sigmoidoscopy and barium enema and are found to be positive again.
Colonoscopy desired as first-line w/u for heme + stool.
Criteria for Return to Primary Care
Completion of colonoscopy with recommendations to the primary care provider.
