UW>>this is a totally werid question - life_saver00
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UW>>this is a totally werid question - life_saver00
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07-10-2007, 05:29 PM
I think u should always do colonsocopy initially for just the reason that coumadin mentioned. If that is uneqivocal then the other test should be employed as bleeds in the small bowel can not be fully reached & visualized by colonoscopy
07-10-2007, 07:29 PM
If melena is present, then probably the source is much proximal. and hence outta reach of colonscope, so scintigraphy is a better option, as it can detect as low as 0.1ml/min bleeding
07-10-2007, 07:41 PM
D is correct since it will tell u the site of bleeding even with low volume of blood and endoscopy will not reveal bleed in the small bowel.
07-10-2007, 07:49 PM
This fellow probably has some angiodysplasia that is teh SECIND MOST COMMON CAUS EOF MASSIVE LOWER BLEEDING..
The NG is to rul eout the UGI and if nothing that is telling us that is the LOWER GI BLEED (HEMATOCHEZIA ) in elderly. MOST COMMONLY LOCATED in the cecum in the rigth colon in elderly ( stomack and duodenum in young ) where the radius of the bowel is greatest and the wall tension is increased, thus predisposing to VESSEL DILATATION. Clinical : associeted with AORTIC STENOSIS and vWd.. signs of iron deficiency Diagnosis of Lower GI Bleed NG tube to rule out UGB Colonoscopy to FIND THE BLEEDING SITE. Other options -TAGGED RBC Angiography, Some colloid sulfur scan BUT in angiodysplasia , dilateted submucosal vessels can b eOCCASIONALLY seen with COLONOSCOPY, So lets tagg teh RBC and go for RBC SCINTIGRAPHY !!!!!!!!!!!!!!!!!
07-10-2007, 07:55 PM
I've had this question. It says in the answer that the patient is not actively bleeding. That's why their answer is tagged RBC scan. You won't find anything with angiography and colonoscopy. Kaplan also says the same thing. Actively bleeding and massive, best diagnosed with angiography. If not that much, colonoscopy, coz you won't see anything if bleeding too much. If bleeding has stopped, tagged rbcs.
07-10-2007, 07:59 PM
The three most common reasons for acute GI hemorrhage for old age group are diverticulosis, angiodysplasia and peptic ulcer disease (PUD).
a, Hematochezia is more suggestive for lower, rather than upper bleeding therefore upper endoscopy is not the first choice. b, Labeled erythrocyte scintigraphy, although not a very precise study, could be helpful to define the site of bleeding . c, Laparotomy, for blind total abdominal colectomy and ileostomy, is reserved only for the situations where the bleeding is persistent and its site can't be found . d, Colonoscopy is difficult and rarely performed in settings of active bleeding. If the bleeding stops, however, it should be done . |
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