DrVirgo
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B or C?
Intestinal ischemia or hematoma?
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| khorshid
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I'll go with hematoma, because of very high INR (risk of bleeding), and also in ischemia wouldn't we have bloody stool?
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| dr in trouble
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In ischemia--u will have severe abdominal pain + bloody diarrhea, ischemia can be d/t hypotension but it is v.unlikely for hypotension to be d/t ischemia.
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| elitoki
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B. ischemia.
When pt is on Warfarin with INR 6 is more probable produce bleeding problem (hematoma), but now she is on NO treatment with AFib. so her symptom is probablely caused by embolus. 
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| khorshid
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But her warfarin was only DC the previous day, and her afib was two weeks ago, I mean you can't expect INR this high to normalize in a day or less.
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| dr_arc
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pt on warfarin. INR 6 a day before the event = bleed, so hematoma.
ishaemia foll an embolus would be right if she were fibrillating now , the question doesnt mention such . infact she has been cardioverted the last time she had a fib
Edited by dr_arc on 07/24/07 - 08:41 PM
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| Justice
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C, although I doubt that hematoma would cause such a drop in her Hb
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| DrVirgo
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I thought ischemia at first also...
Hematoma- final answer?
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| Drtweetie
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I'll go with hematoma.
INR doesn't normalize in 1 day, w/ elevated INR the day before, dropping Hb--> hematoma
Cannot be ischemia b/c usually no peritoneal signs on exam. In this case, pt has guarding.
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| dr19
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Hb dropped>5g.............hematoma
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| coolmavs
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Ishemia will haveto give a + FOBT, if there is such a massive drop of Hb!
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