amit_k_m
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Q. To localize the source of hematochezia in a 70-year-old man, which one of the following is the most appropriate sequence of diagnostic tests?
a). Barium enema, nasogastric intubation, sigmoidoscopy
b). Nasogastric intubation, colonoscopy, angiography
c). Rectal examination, angiography, sigmoidoscopy
d). Colonoscopy, gastroscopy, CT scan of the abdomen
Can u explain why u think its B...
I think it should be the last one.... Coloscopy, gastroscopy and CT scan..... as this man is 70 yrs old loer GI bleed is more likely. so colonoscopy should be the first followed by gastroscopy as upper GI blees may also present as hematochezia. finally CT.
" Helical CT scan of the abdomen and pelvis can also be used when routine workup fails to determine the cause of active GI bleeding. Multiple criteria including vascular extravasation of the contrast medium, contrast enhancement of the bowel wall, thickening of the bowel wall, spontaneous hyperdensity of the peribowel fat, and vascular dilatations are used to establish the bleeding site with helical CT. The presence of diverticula alone was not enough to define the bleeding site. Three-phase helical CT should be performed using intravenous contrast. Water can be used as an oral contrast in the workup of patients who are actively bleeding. Therefore, helical CT could be a good diagnostic tool in acute lower gastrointestinal bleeding to help the physician identify the bleeding site."
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-Amit
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| achilles
Forum Guru
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even in older patients upper GI bleeding is still the most common cause. its just that relatively lower GI bleeds are much more commoner in older men than in the young. hope that helps.
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| srf
Forum Guru
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additionally nasogastric intubation is easy to perform.it is high yield also .if we find cause by it patient will not need costly investigation.hematochezia can occur from any site of GIT.point mentioned by achilles is most important.
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| amit_k_m
Forum Newbie
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thnks.. achilles n srf.
I got confused because I read somewhere that in older persons u should do anoscopy n rectal examination first and then go for upper GI investigations.
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-Amit
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| alphahmed
Forum Junior
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I believe that the answer is C.
it is more logical and precise... we are dealing with bleeding not intestinal obstruction.
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