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ما الخطوة التالية في هذا النزف الهضمي؟


ما الخطوة التالية في هذا النزف الهضمي؟


حالة سريرية

الوصف الكامل Background
A 63-year-old man in apparent good health is convinced by magazine articles and TV programs that he will live longer if he takes one aspirin tablet every day. After about 3 weeks of doing so (325 mg/day), he begins to notice bright red blood in the toilet paper when he wipes after a bowel movement. This does not occur every time, but only when, for whatever reason, he has to strain more than usual. He has never had any discomfort referable to hemorrhoids, or any bowel pathology that he is aware of. Anoscopy and digital rectal examination show external and internal hemorrhoids, none of which are bleeding at the time of the examination. Which of the following is the most appropriate next step in management?

A.Discontinue the aspirin
B.Perform rubber-band ligation of the internal hemorrhoids
C.Perform 60-cm flexible proctosigmoidoscopy
D.Recommend stool softeners
E.Reduce the aspirin dosage

the best's picture
by
طالب دراسات عليا


.Perform 60-cm flexible proctosigmoidoscopy

a.m.a's picture
a.m.a
طبيب مقيم

C.Perform 60-cm flexible proctosigmoidoscopy
Fouad's picture
Fouad
بعد التخرج


ممكن يكون داء الرتوج نزف بسبب الأسبرين

.b's picture
.b
بعد التخرج

Quote:
ممكن يكون داء الرتوج نزف بسبب الأسبرين
maybe.... but the most important concern here is colonic cancer....
Fouad's picture
Fouad
بعد التخرج


I wonder if this question is old .
This patient is more than 50 years old and although flex sig could be sufficient to ascertain the source of bleed but it is substanderd and the patient will need FULL COLONOSCOPY.

See this from uptodate regarding minimal lower GI bleed in ages above 50
"Age 50 or older — Most authors agree that colonoscopy is the test of first choice in patients over 50 to 55 years of age. In addition, the American Gastroenterological Association and the United States Multisociety Task Force on Colorectal Cancer recommend that colon cancer screening in patients with "average risk" begin at age 50 years. For these reasons, we believe that patients over 50 years of age with scant rectal bleeding should undergo colonoscopy regardless of the presence or absence of identified anorectal pathology on clinical examination."

ABIM's picture
ABIM


I going with C

shadowmaster
السنة السادسة


c

dr-askar
السنة السادسة


برافو
الجواب الصح هو C
لأننا يجب أن ننفي وجود سرطان كولون قبل أن نقول أن سبب النزف هو بواسير داخلية أو خارجية أو شيء آخر

Quote:
This patient is more than 50 years old and although flex sig could be sufficient to ascertain the source of bleed but it is substanderd and the patient will need FULL COLONOSCOPY

أنا أيضاً مع تنظير الكولون كاملاً(لو كان في هيك احتمال بين الاحتمالات)

the best's picture
the best
طالب دراسات عليا
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