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Old 07-16-2012
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GIT Blood per rectum; Next Step!

A 45-year-old Mexican male presents with a 2-day history of traces of blood on the tissue paper after he wipes. He does not have gross blood mixed with stool, but on one occasion there were drops of blood in the toilet after defecation. He has no past medical history or family history of cancer or other significant disease.
Which of the following is the most appropriate next step in management?

A. Colonoscopy
B. Fecal occult blood test
C. Anoscopy
D. Sigmoidoscopy
E. Barium enema
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Old 07-16-2012
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C. Anoscopy
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Old 07-16-2012
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Quote:
Originally Posted by mbbs2010 View Post
C. Anoscopy
please give expln
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Old 07-16-2012
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Quote:
Originally Posted by tyagee View Post
A 45-year-old Mexican male presents with a 2-day history of traces of blood on the tissue paper after he wipes. He does not have gross blood mixed with stool, but on one occasion there were drops of blood in the toilet after defecation. He has no past medical history or family history of cancer or other significant disease.
Which of the following is the most appropriate next step in management?

basically you have to check for the site of his bleed for which you'd need to scope.

and if you read kaplan Sx notes it says that before doing any kind of scopy (colono/sigmoidoscopy) FIRST VISUALIZE THE ANAL CANAL.


fecal occult blood seems less likely.

and also barium enema -- would involve administration of enema and then taking pictures. where as anoscopy would be less tedious and less expensive.
also barium enema is not a first step.
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Old 07-16-2012
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Anoscopy is not as invasive as a colonoscopy (no general anesthesia) , can be done in the clinic. And its very suggestive of hemmhoroids, plus, he is still not in the ''risk age for colon cancer'' unless he had a family history or a genetic predisposition.
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Old 07-17-2012
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Originally Posted by mbbs2010 View Post
basically you have to check for the site of his bleed for which you'd need to scope.

and if you read kaplan Sx notes it says that before doing any kind of scopy (colono/sigmoidoscopy) FIRST VISUALIZE THE ANAL CANAL.


fecal occult blood seems less likely.

and also barium enema -- would involve administration of enema and then taking pictures. where as anoscopy would be less tedious and less expensive.
also barium enema is not a first step.
What will be ans if this patient be 60 years ?
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Old 07-17-2012
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Originally Posted by tyagee View Post
What will be ans if this patient be 60 years ?



although there is higher indication of doing colonoscopy... but still anoscopy will be before colonoscopy.

because if you can find the cause with it... the patient will not need colonoscopy or any other diagnostic test.

again like LatinGeorge said --- ease of doing, cost effective, OPD procedure
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