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Old 09-11-2012
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Default bloody bowel movement in a 7 year old boy

A 7-year-old boy passes a large, bloody bowel movement. He is hemodynamically stable, and he has a hemoglobin of 14 g/dL. Nasogastric aspiration yields clear, greenish fluid. Physical examination, including anoscopy, is unremarkable. Which of the following is the most appropriate next diagnostic test?

A. Celiac arteriogram
B. Colonoscopy
C. Radioactively labeled technetium scan
D. Radioactively tagged red cell study
E. Upper gastrointestinal endoscopy
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Old 09-11-2012
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Answer C

nasogastric suction reveals greenish fluid ,this excludes upeer GI bleed.Meckels I guess is common cause of painless lower GI bleed in a child

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Old 09-11-2012
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meckel will not cause such a large bleed

plus colonoscopy not helpful in acute bleed so will go with D .......
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C. Radioactively labeled technetium scan

For mechals for ectopic gastric mucosa...
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Quote:
Originally Posted by Hitman View Post
meckel will not cause such a large bleed

plus colonoscopy not helpful in acute bleed so will go with D .......
yes its meckels i guess , i am over thinking these qs .......
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The correct answer is
C
. In this age group, with no obvious anal pathology and negative gastric aspirate, the leading cause of gastrointestinal bleeding is Meckel's diverticulum. The specific source is ulceration of the normal ileal mucosa by acid produced by gastric mucosa in the diverticulum. The technetium scan identifies that ectopic gastric mucosa. Arteriogram (choice A) as a diagnostic step is a very invasive study that is appropriate only for very large hemorrhage (>2 mL/min) with clear gastric aspirate. An arteriogram may also be indicated for therapy (embolization) in severe gastrointestinal bleeding. Colonoscopy (choice B) would not identify the Meckel's diverticulum. Colonoscopy is often needed in the older patient with lower gastrointestinal bleeding, in whom the source of the hemorrhage is likely to be polyps, cancer, diverticula, or angiodysplasia. A tagged red cell study (choice D) is often used as a prelude to an arteriogram in patients with substantial lower gastrointestinal bleeding. Upper gastrointestinal endoscopy (choice E) would have been appropriate if the gastric aspirate had produced blood.
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