another GI bleed - darkhorse

[ArchivalUser]

darkhorse have u replied somewhere for this quest.

[ArchivalUser]

darkhorse ans pls???

[ArchivalUser]

C.....failure of embolization/coiling

[ArchivalUser]

ans pl

[ArchivalUser]

The answer is B.

The patient is presenting with a large-volume lower GI bleed that most likely is due to
diverticular disease in light of his age and history of hypertension. Other common causes of
lower GI bleeding include arteriovenous malformations and colon cancer. The patient received
appropriate initial management with volume resuscitation and blood transfusion therapy. The
other initial step in management is localization of the bleeding source. Modalities to localize the
bleeding site include radionucleotide-tagged red blood cell scan and colonoscopy. This patient
has undergone a tagged red blood cell scan that localized the bleeding source to the right side
of the colon. Thus, colonoscopy would not aid in localization and would only delay the
procedure of choice: mesenteric angiography with selective embolization or coiling of the culprit
artery. The complication rate of this procedure is low, with fewer than 10% of patients
developing colonic ischemia. There is an approximately 25% risk of acute rebleeding.
Indications to proceed with surgical intervention include unstable vital signs or a requirement of
more than 6 units of packed red blood cells in 24 h. Vasopressin therapy was used in the past
for acute treatment of diverticular bleeding but has fallen out of favor because of a high
complication rate and a high rebleeding rate. Myocardial infarction or intestinal ischemia occurs
in over 40% of patients, with rebleeding occurring in 50% after discontinuation of the drug.

[ArchivalUser]

c...