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  #1  
Old 10-20-2012
billy's Avatar
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Arrow Billy Step 1 Questions # 41

A 66-year-old woman presents to her physician
because of recurrent painless bleeding on defecation
over the past month. She has regular,
soft bowel movements and no history of constipation
or diarrhea. A recent diagnosis of aortic
stenosis was an incidental fi nding on echocardiogram.
She takes calcium and vitamin D
supplements daily. Her last colonoscopy (at age
60) was normal. Heart rate is 82/min, blood
pressure is 133/72 mm Hg, respiratory rate is
12/min, and temperature is 36.6°C (97.8°F).
Physical examination reveals her conjunctivae
are pink and mucosa is moist. She has no abdominal
tenderness or palpable masses and no
hemorrhoids or fi ssures. Stool is hemoccult
positive. Colonoscopy shows a spider-like lesion
in the ascending colon. Which of the following
is the most likely diagnosis?


(A) Angiodysplasia
(B) Crohn’s disease
(C) Diverticulosis
(D) Ischemic colitis
(E) Peptic ulcer disease
(F) Ulcerative colitis
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  #2  
Old 10-20-2012
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will go with A) angiodysplasia----spider like telangiectasias????

2nd mcc of hematochezia after diverticulosis(1st mcc)

thanks
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Old 10-20-2012
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Angiodysplasia... Hands down!
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  #4  
Old 10-20-2012
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Quote:
Originally Posted by billy View Post
A 66-year-old woman presents to her physician
because of recurrent painless bleeding on defecation
over the past month. She has regular,
soft bowel movements and no history of constipation
or diarrhea. A recent diagnosis of aortic
stenosis was an incidental fi nding on echocardiogram.
She takes calcium and vitamin D
supplements daily. Her last colonoscopy (at age
60) was normal. Heart rate is 82/min, blood
pressure is 133/72 mm Hg, respiratory rate is
12/min, and temperature is 36.6°C (97.8°F).
Physical examination reveals her conjunctivae
are pink and mucosa is moist. She has no abdominal
tenderness or palpable masses and no
hemorrhoids or fi ssures. Stool is hemoccult
positive. Colonoscopy shows a spider-like lesion
in the ascending colon. Which of the following
is the most likely diagnosis?


(A) Angiodysplasia
(B) Crohn’s disease
(C) Diverticulosis
(D) Ischemic colitis
(E) Peptic ulcer disease
(F) Ulcerative colitis
I too think A.ANGIODYSPLASIA..
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  #5  
Old 10-20-2012
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Default my answer A

absolutely angiodysplasia and its relation w/aortic stenosis
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Old 10-20-2012
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my answer is A
angiodysplasia-dilation of mucosal and submucosal venules in cecum and right colon,occurs in elderly individuals ,vascular ectasias in the cecum increase with age,increased wall stress in the cecum stretches the venules,clinical findings-hematochezia(angiodysplasia -second most common cause hematochezia)association with von willebrand disease and calcific aortic stenosis
diagnosis with colonoscopy and angiography
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  #7  
Old 10-21-2012
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Correct Answer A is correct

Angiodysplasia is the
second leading cause of painless lower GI
bleeding in patients >60 years old. The lesion
is usually “fern-like” or “spider-like” with a tendency
to bleed, ranging from occult blood to
melena to frank hematochezia. Lesions are
typically in the cecum or ascending colon and
can be associated with aortic stenosis. Patients
should fi rst be stabilized, then treated with
electrocoagulation or embolization through
angiography.
Answer B is incorrect. Crohn’s disease does
not typically cause severe bleeding, but frank
blood is seen in approximately 30% of patients.
Affected patients are more likely to have abdominal pain, anorexia, diarrhea, fatigue, and
fever. The diagnosis is made and confi rmed by
biopsies obtained by colonoscopy. Exacerbations
of Crohn’s disease are managed medically
with bowel rest, nasogastric suctioning, intravenous
fl uids, and immunosuppressive agents.
Surgery is generally not indicated.
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