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  #1  
Old 04-06-2011
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GIT Lower GIT bleeding in elderly

I face a problem with this issue typically about the most common causes in what order...!!??
as it is mentioned in 3 different positions in FA Q&A opposing each other
as regarding order of which is common than the other

1st ....
1. Diverticulosis 42-55%
2. CA colon 8-26%
3. Angiodysplasia 3-12%

2nd ....
1. diverticulosis ....leading cause of painless lower git bleed
2. angiodysplasia ...2nd leading cause of painless lower git bleed

3rd ...
angiodysplasia is the most common cause of lower git bleeding in elderly

I am confused about this... anyone can help... ????
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Old 04-06-2011
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Hi Cerebrum, I wouldn't get too caught up in the numbers, since seems to depend on which age group and which study you look at...

From UpToDate: "In most series, diverticulosis accounts for approximately 15 to 55 percent and angiodysplasia for 3 to 37 percent of LGIB. Angiodysplasia may be the most frequent cause in patients over the age of 65, though more recent data suggest that angiodysplasia may be a less common cause of LGIB than once thought.

In a review of several large studies that included 1559 patients with acute LGIB, the following bleeding sources were identified:

Diverticulosis — 5 to 42 percent
Ischemia — 6 to 18 percent
Anorectal (hemorrhoids, anal fissures, rectal ulcers) — 6 to 16 percent
Neoplasia (polyps and cancers) —3 to 11 percent
Angiodysplasia — 0 to 3 percent
Postpolypectomy — 0 to 13 percent
Inflammatory bowel disease — 2 to 4 percent
Radiation colitis — 1 to 3 percent
Other colitis (infectious, antibiotic associated, colitis of unclear etiology) — 3 to 29 percent
Small bowel/upper GI bleed — 3 to 13 percent
Other causes — 1 to 9 percent
Unknown cause — 6 to 23 percent"
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The literature varies about this issue. However, it's mostly accepted that Diverticulosis is by far the most common cause.
References:
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Quote:
Originally Posted by lee-usmle View Post
The literature varies about this issue. However, it's mostly accepted that Diverticulosis is by far the most common cause.
References:

yes that it is....... most common is diverticulosis
then it varies...

thx both of u for ur care
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Old 04-06-2011
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when i was solving uw this question came

angiodysplasia is the most common cause of lower git bleeding in elderly with normal mcv and decrease Hb and with history of aortic stenosis (systolic ejection murmur in 2nd RT intercostal space; there is there is link bet AS and angiodysplasia)
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Old 04-07-2011
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Arrow acute/chronic and major/minor bleed matters

Hi everyone,
Yes, according to step up, diverticular disease is most common cause of acute lower GI bleed in patients> 40 y.o.
Also here is directly from Merck Manual:

"Geriatrics Essentials
In the elderly, hemorrhoids and colorectal cancer are the most common causes of minor bleeding. Peptic ulcer, diverticular disease, and angiodysplasia are the most common causes of major bleeding. Variceal bleeding is less common than in younger patients.
Massive GI bleeding is tolerated poorly by elderly patients. Diagnosis must be made quickly, and treatment must be started sooner than in younger patients, who can better tolerate repeated episodes of bleeding"

I will check my Kaplan notes when I get home, and post an update on here from the Kaplan notes...don't have them with me...3am library time is almost done, so soon I will post update
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Old 04-07-2011
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Quote:
Originally Posted by Medtobe View Post
Hi everyone,
Yes, according to step up, diverticular disease is most common cause of acute lower GI bleed in patients> 40 y.o.
Also here is directly from Merck Manual:

"Geriatrics Essentials
In the elderly, hemorrhoids and colorectal cancer are the most common causes of minor bleeding. Peptic ulcer, diverticular disease, and angiodysplasia are the most common causes of major bleeding. Variceal bleeding is less common than in younger patients.
Massive GI bleeding is tolerated poorly by elderly patients. Diagnosis must be made quickly, and treatment must be started sooner than in younger patients, who can better tolerate repeated episodes of bleeding"

I will check my Kaplan notes when I get home, and post an update on here from the Kaplan notes...don't have them with me...3am library time is almost done, so soon I will post update

great
That is adding in lifting the confusion .. of this issue .
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Old 04-07-2011
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Embarrassed sorry for delay

Sorry for the delay, I kinda had 3hrs to sleep before starting hospital today, so just went to bed:
1. Nothing in Kaplan notes
2. nothing in step 2 secrets
3. looked at Saunder's Manual of medicine and agrees with Merck Manual, they explain :
"the frequency bleed is influenced by age, weather a study is been done on particular bleed, in patient or out patient , and occult, small or massive.

After this I can say that the % or numbers will never be asked, but in general:

Minor bleed---> hemorrhoids and colorectal cancer---> differentiate by other signs and symptoms.

Major bleed---> Peptic ulcer, diverticular disease, and angiodysplasia( and as mentioned keep in mind, it's association with aortic valve disease.)
http://www.ncbi.nlm.nih.gov/pubmed/312746

Mean while keep in mind that Diverticular disease is #1 as Acute cause of major bleed.

ok, back to my very fun psych rotation

Hope this helps
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Old 04-07-2011
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Smile THX again

Quote:
Originally Posted by Medtobe View Post
Sorry for the delay, I kinda had 3hrs to sleep before starting hospital today, so just went to bed:
1. Nothing in Kaplan notes
2. nothing in step 2 secrets
3. looked at Saunder's Manual of medicine and agrees with Merck Manual, they explain :
"the frequency bleed is influenced by age, weather a study is been done on particular bleed, in patient or out patient , and occult, small or massive.

After this I can say that the % or numbers will never be asked, but in general:

Minor bleed---> hemorrhoids and colorectal cancer---> differentiate by other signs and symptoms.

Major bleed---> Peptic ulcer, diverticular disease, and angiodysplasia( and as mentioned keep in mind, it's association with aortic valve disease.)
http://www.ncbi.nlm.nih.gov/pubmed/312746

Mean while keep in mind that Diverticular disease is #1 as Acute cause of major bleed.

ok, back to my very fun psych rotation

Hope this helps

sure man this is helpful....... thx 4 ur effort
i think it is a buzzling matter.. making it area of good discussion and studies rather than exams.... i hope soo
enjoy ur psych rotation
i ll prepare some psych.Q 2 discuss ...
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Old 04-08-2011
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Default no problem

no problem, if we don't help each other clarify complicated topics...who will!!! Plus we learn more
and ..lol...thanks but no psych topics, I am not a big fan of psych
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Old 04-10-2011
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Quote:
Originally Posted by miss patho View Post
when i was solving uw this question came

angiodysplasia is the most common cause of lower git bleeding in elderly with normal mcv and decrease Hb and with history of aortic stenosis (systolic ejection murmur in 2nd RT intercostal space; there is there is link bet AS and angiodysplasia)
Although i have not yet completed UW 100% but I came across a similar question,so i am guessing that it was the same one...the trick in that question was that the patient had a recent colonoscopy which was normal...that rules out diverticulosis, but angiodysplasias are often missed on colonoscopy...and to give us a clue they gave us a systolic murmur on P/E (aortic stenosis, which is associated with angiodysplasia)

Hope it helps
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Old 04-12-2011
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Quote:
Originally Posted by docsur View Post
Although i have not yet completed UW 100% but I came across a similar question,so i am guessing that it was the same one...the trick in that question was that the patient had a recent colonoscopy which was normal...that rules out diverticulosis, but angiodysplasias are often missed on colonoscopy...and to give us a clue they gave us a systolic murmur on P/E (aortic stenosis, which is associated with angiodysplasia)

Hope it helps

i think this unlock the last puzzle of the matter............thx a lot
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