Hx:
70 y/o male
CC: hematochezia x 2 mo.
+ moderate, intermittent bleeding (worsened over last 2 days)
+ constipation, weight loss, fatigue x 3 mo.
PMH: internal hemorrhoids
(-) DRE 1 yr ago, (-) sigmoidoscopy 6 yrs ago
remote 20 pack-year hx

PEx:
VSS s/p IVF
Abd: NABS. Firm, slightly distended, NT, no HSM
Rectal: no palpable masses, (+) guaiac