تصفح
دخول
تسجيل
نسيتها؟

female with lower GI bleeding


female with lower GI bleeding


حالة سريرية

الوصف الكامل Background

45 years old married lady came to ER complaining of abdominal pain for the last 3 days and today she noticed blood in her stools, no diarrhea, no constipation, no previous history of hemorrhoids or anal pain.

the patiant is hyperlipidemic and suffers multi-arthralgias and she is using the following perscribed medications:

tramadol
diclofenac sodium
pravastatin
orlistat
calcium carbonate + vit d3
adavit
lansoprazole

كتابة حرة وطرح موضوع النقاش!

what do you think is happening with the patiant?

what is your next step?

dr.tabban's picture
by


helloooooooooooooooooooooooooo Exclamation Exclamation Exclamation Exclamation

dr.tabban's picture
dr.tabban


I have a comment on the title.
When you say anal bleeding that means you examined the patient and determined that the source of bleeding is the anus itself.
I believe you should say lower GI bleed (which in its differntial includes anal disorders)

ABIM's picture
ABIM


the NSAIDS she is taking is causing the bleeding it even causes colon ulcers.
Stop the drug, do colonoscopy

Hot sauce's picture
Hot sauce
طبيب مقيم

Some DDx:
colon ulcer relating to NSAIDs
بهجت
كرون
First line investigation is:
anal examination then colonoscopy
KMG's picture
KMG
طبيب مقيم


لماذا قلت بهجت؟؟؟

Hot sauce's picture
Hot sauce
طبيب مقيم


يا لطيف!! شو هالتخبيص!!

عفواً مو بهجت.. داء الكولون القرحي ulcerative colitis!

هذه الأدواء تسبب نزف هضمي سفلي لذلك وضعتها. حتى لو أن العلامات المرافقة لهما غير مذكورة لكن يمكننا تبيان ذلك عن طريق الفحص السريري.

KMG's picture
KMG
طبيب مقيم


but bleeding in crohn is rare
UC is right too

Hot sauce's picture
Hot sauce
طبيب مقيم


ok
i expected little longer discussion but it's understandable since all of you are busy in the examinations.
y question now will be this:

do you think we should do lower endoscpoy or upper one or both?, make your answer based on the indications you already have now, and knowing the the anal examination was negative for ractal mass, hemorrhoids, and anal fissuer.

why didn't you think of diverticulosis? polyps? or maybe you thought of it when you requested coloscopy?

dr.tabban's picture
dr.tabban


ISCHEMIC COLITIS WILL CAUSE ABDOMINAL PAIN BUT ABDOMINAL XRAY WILL BE HELPFULL IN THIS CASE
BUT THE PATIENT IS USING LANSAPROZOL SO SHE HAVE GASTRIC OR DOUDENAL ULCER AND SHE IS USING DICLOFENAC SODUM WHICH PREDESPOSE THE ULCER SO UPPER ENDOSCOPY IS HELPFULLEye-wink

golden rose
بعد التخرج
ابق على تواصل مع حكيم!
Google+