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 GIT bleed  



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Author7 Posts
  #1

middle aged man with 4 large bowel movt's of entirely dark red blood .pt is diaphoretic ,Bp is 90/70 ,PR is 115 .

:arrow: What is the line of treatment next ?

:arrow: If NG tube returns bile stained blood ?
:arrow: NG tube returns frank blood ?
:arrow: Ng tube returns clear fluid ?
:arrow: when do we go for tagged red cell study ??




  #2

1.Secure an iv and stabilise the patient.
2.If NG tube shows bld go for endoscopy for source
(Is the Mx diff in 2 and 3?)
4.Go for a colonoscopy
5.Colonoscopy reveals no source but pt is bleedidng and for now he is realtively stable


  #3

4--colonoscopy is not helpful during active bleeding
we ist do anoscopy ( to rule out bleeding hemorrhoids)
angiogram is the best way to find a source if bleeding more than 2ml/min
if bleeding less than .5ml/min then go for tagged red cell studies ,or wait untill bleeding stops & then do colonoscopy


  #4

Dimps both CMDT and Kaplan say you try colonoscopy 1st and in case it fails you go for targetted red cell studies.Pls clarify


  #5

i m writing all this from kaplan surgery pg 33


  #6

And I did that from Kaplan GIT.Man how do they expect us to know what they themselves dont know.Can you(Dimps) pls look up CMDT and tell me if I misunderstood the implications?


  #7

I m not having this book right now ,but tomorrow i will go to the library & try to solve this confusion





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