OK, we start with Cricoid's cake, just baked ! - triplehelix

[ArchivalUser]

60.
A 24-year-old engineer is evaluated because of periumbilical abdominal pain and hematochezia. Four months ago, he was hospitalized because of a similar episode. At that time, his hemoglobin level was 10.8 g/dL (108 g/L), and blood transfusions were not required. Upper endoscopy, colonoscopy with intubation of the terminal ileum, and capsule endoscopy (capsule enteroscopy) were normal, and he was discharged after several days of observation.

The patient remained asymptomatic until 2 days ago, when the periumbilical abdominal pain recurred. Last night, he had another episode of hematochezia.

On physical examination this morning, he appears anxious but in no acute distress. He has not had a bowel movement since last evening. Vital signs and general examination are normal, and his hemoglobin level is 9.8 g/dL (98 g/L).

Which of the following diagnostic studies should be performed next?

A Extended upper endoscopy
B Tagged red blood cell scan
C Meckel's scan
D Repeat capsule endoscopy
E Intraoperative endoscopy

[ArchivalUser]

Allow me the honour of taking the first bite
The answer is C

[ArchivalUser]

C Meckel's scan

[ArchivalUser]

B.

[ArchivalUser]

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[ArchivalUser]

b.

[ArchivalUser]

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[ArchivalUser]

correct answer is C.

This patient has had a second episode of acute gastrointestinal bleeding in 4 months. Initial diagnostic studies, including upper endoscopy, did not identify a bleeding source. Because of the patient's young age and periumbilical pain, he may have a Meckel's diverticulum and a radionuclide study (Meckel's scan) should be done next. If this study is normal, repeat capsule endoscopy should be considered.

Extended upper endoscopy, in which a longer endoscope is used to intubate the small bowel beyond the duodenum, is sometimes helpful in determining the cause of obscure gastrointestinal bleeding. However, this study has a higher yield in older patients who are more likely to have angiectasias. A tagged red blood cell scan requires active bleeding and is therefore unlikely to be diagnostic in this patient, who is hemodynamically stable and does not have evidence of ongoing bleeding.

Although intraoperative endoscopy has the highest yield for identifying a source of small bowel bleeding, it is an invasive procedure and is indicated only if other less invasive studies are nondiagnostic.