12-16-2007, 06:09 AM
darkhorse have u replied somewhere for this quest.
another GI bleed - darkhorse
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12-16-2007, 06:09 AM
darkhorse have u replied somewhere for this quest.
12-17-2007, 05:16 AM
darkhorse ans pls???
12-17-2007, 05:56 AM
C.....failure of embolization/coiling
12-17-2007, 07:59 AM
ans pl
12-17-2007, 08:04 AM
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.
12-17-2007, 11:24 AM
c...
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