robin082006
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The relatives of a 78-year old man, with Alzheimer’s disease, brought him to the clinic because they had noted tarry stools. He has chronic constipation and is being treated with bisacodyl. His vital signs were, PR: 90/min; BP: 120/70mm of Hg, no orthostatic change; RR: 14/min; Temperature: 36.6C(97.9F). Rectal exam revealed melena. Nasogastric tube showed normal stomach content without blood. Sigmoidoscopy showed no pathology and no active bleeding. A barium enema had just been performed, when hematochezia was noted. His PR and BP currently were: 90/min and 120/70mm Hg, supine; 100/min and 110/70mm of Hg, standing. Barium enema showed no pathology. What is the next most appropriate step in management for this patient?
A. Upper endoscopy
B. Colonoscopy
C. Angiography
D. Labeled erythrocyte scintigraphy
E. Laparotomy
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| sarika
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D. Labeled erythrocyte scintigraphy
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| lecheah
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i think upper endoscopy, because
1)malena=UGIB
2)"Nasogastric tube showed normal stomach content without blood" means nothing if patient is not actively bleeding when NG tube was inserted
anyway, what's the ans pls
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| chemamr
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it looks like an Upper GI bleeding, so, I think it's A.
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| Aashi
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NG--> normal, no upper G.I bleed
Sigmoidoscopy--> normal, no LOWER G.I bleed, A COLONSCOPY for viewing the whole colon is done if the pt isnt actively bleeding, and ANGIOGRAPHY is done when there is massive bleed,the clinical pic and the vital signs doesnt support that...
So to look for the source of bleed in the small intestine lets do a Labeled erythrocyte scintigraphy -( TAGGED RBC study)--> D
Edited by Aashi on 01/21/07 - 04:02 PM
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| chemamr
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Robin: finish the mystery, what's the answer?
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| anjushree
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why not colonoscopy?
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| robin082006
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Answer is D,
This patient may have angiodysplasia
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| paviraj
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D.Given in usmle world GIT section
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