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NBT Colorectal Referral Guidelines

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22/01/2007

Presenting symptoms

Age criteria

Diagnostic Investigations

(2 week referral)

Rectal bleeding persisting for 6 weeks or more without a change in bowel habit and without anal symptoms

> 60 years; aim to reach over 45 years

Fibre optic sigmoidoscopy

Change of bowel habit, to looser stools and/or increased frequency persisting for 6 weeks or more

> 60 years

Barium enema

Rectal bleeding and change in bowel habit towards looser stools and/or increased frequency for at least six weeks

> 40 years

Barium Enema

Palpable mass; abdominal/ intraluminal rectal

All Ages

Colorectal Outpatient clinic

Unexplained iron deficiency anaemia (hypochromic,

microcytic)

Hb below 11g/dL in men,

Hb below 10g/dL in non-menstruating women

All ages

Barium enema;

Direct to gastroscopy if normal

Any of these symptoms

unfit/immobile

Colorectal Outpatient clinic

 

































NBHT CR Cancer Diagnostic Protocol

If the referring clinician has a reasonable index of suspicion for a colorectal cancer diagnosis, they should consider referring the patient under the 'two week rule' (where the hospital is mandated to offer an appointment within two weeks of the decision to refer).  It is important to remember however that most patients referred under this system will not prove to have a cancer diagnosis and that conversely, the majority of colorectal cancers are not referred under the two week rule.  Consequently, the hospitals endeavor to see all referrals with lower gastrointestinal symptoms within a reasonable time-frame.



NBHT CR non CANCER DIAGNOSTIC PROTOCOL

Presenting symptoms

Age criteria

Diagnostic Investigation

Rectal bleeding and anal symptoms

All ages

13 Week Colorectal Outpatient clinic

(11 weeks from March ’07 and working towards 18 week pathway)

Incontinence without change in bowel habit

All Ages

13 Week Colorectal Outpatient clinic

(11 weeks from March ’07 and working towards 18 week pathway)

Anal symptoms of Itch, Pain or Prolapse

All Ages

13 Week Colorectal Outpatient clinic

(11 weeks from March ’07 and working towards 18 week pathway)

Abdominal pain alone or

Weight loss alone

All ages

13 Week Colorectal Outpatient clinic

(11 weeks from March ’07 and working towards 18 week pathway)

Change in Bowel Habit; increased frequence and/or looser stools

< 40 years

> 40 years but <60 years

13 Week Colorectal Outpatient clinic

13 Week Barium Enema

(11 weeks from March ’07 and working towards 18 week pathway)

Change of Bowel Habit; constipation

< 60 years

13 Week Colorectal Outpatient clinic

(11 weeks from March ’07 and working towards 18 week pathway)




















































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