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USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


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Old 09-22-2011
iron's Avatar
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Default bleeding PR

pt with recent h/o blood per rectum ,what is the intial test?
young pt : start with upper endoscopy
old pt : start with both upper and lower endoscopy same session
red bld per rectum can be from anywhere so 1st diagnostic maneveur is ng aspirate.
these r from kaplan notes, but wouldn't be it appropiate for elderly pt coming with bleeding pr to start with anoscopy regardless of the fact that 3/4 of bleeding originate in upper GI and in elderly lower GI bleeding is more common ,combing both facts ,LGIB can be anywhere for elderly ,but is it wrong to start with anoscopy ,sigmiodscopy in them ?
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Old 09-22-2011
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Originally Posted by iron View Post
pt with recent h/o blood per rectum ,what is the intial test?
young pt : start with upper endoscopy
old pt : start with both upper and lower endoscopy same session
red bld per rectum can be from anywhere so 1st diagnostic maneveur is ng aspirate.
these r from kaplan notes, but wouldn't be it appropiate for elderly pt coming with bleeding pr to start with anoscopy regardless of the fact that 3/4 of bleeding originate in upper GI and in elderly lower GI bleeding is more common ,combing both facts ,LGIB can be anywhere for elderly ,but is it wrong to start with anoscopy ,sigmiodscopy in them ?
I suppose the rule is to first rule out UGB, do NG tube, or, if you're going to do upper endoscopy anyway, there's little role for NG tube. Then, you do lower GI approach which is difficult depending on the situation.. Anoscopy is good but will miss a lot, unless you're really sure it's only hemorrhoids. Colonoscopy: if important bleeding you're not going to see much because of the blood; also, if patient isn't correctly prepared (bowel emptying) you're not going to see much. In those cases, depending on the amount of bleeding consider angiography,or if less nuclear scan.
Also, and just to add..., in children think Meckel diverticulum and do technetium scan.
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Old 09-22-2011
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I suppose the rule is to first rule out UGB, do NG tube, or, if you're going to do upper endoscopy anyway, there's little role for NG tube. Then, you do lower GI approach which is difficult depending on the situation.. Anoscopy is good but will miss a lot, unless you're really sure it's only hemorrhoids. Colonoscopy: if important bleeding you're not going to see much because of the blood; also, if patient isn't correctly prepared (bowel emptying) you're not going to see much. In those cases, depending on the amount of bleeding consider angiography,or if less nuclear scan.
Also, and just to add..., in children think Meckel diverticulum and do technetium scan.
yes, u r rite, but what about the best intial step/next appropiate step in elderly pt with recent PR bleeding ,which is not active bleeding ?
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Old 09-22-2011
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yes, u r rite, but what about the best intial step/next appropiate step in elderly pt with recent PR bleeding ,which is not active bleeding ?
Schedule upper and lower endoscopy after proper preparation for it. It's not active bleeding, I assume pt hemodynamically stable and no acute anemization.., then you have 24 hours (or more) to prepare them properly. Usually, do upper endoscopy first, like already mentioned, and then colonoscopy (in that setting, anoscopy or simple sigmoidoscopy is not worth it, as you can miss right side colon bleeding and or simultanous lesions, often seen in lower GI tract).
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