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Discussion Starter · #1 ·
based on UW concept, but changed not to infringe on copyright
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You walk into the evaluation room, where you meet a pleasant 67-y.o. female, who complains of painless rectal bleeding for the past couple weeks. She says that the blood is bright red. She is not sure how much of the blood is there, because it was mixed with stool. You perform a physical exam and collect her history, you note a systolic murmur in her right second intercostal space, that decreases when she stands up. She had a colonoscopy performed 3 months ago that revealed a polyp, which was subsequently removed. She eats a usual diet and has a bowel movement at least once per day.

Her Hct is 37%
BUN - 21
Creatinine - 2.3

What pathology is most likely related to her current condition?

a) platlet consumption
b) RBC destruction
d) ADP deficiency
e) Factor VII deficiencey
f) vWF disruption
g) Platlet inactivation due to uremia
h) Factor V deficiency
 

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i read " some controversial association between AS and angiodysplasia "
but what does it have to do with vWf disruption?
when the blood flows through the valve which is stenotic it damages the VWF and thus ends up leading to bleeding. that is the mechanism behind it.
So, this is a very good question to test your knowledge as to the concept. But, my question to the person who posted it is, I have done u world and they don't have any question with this concept in it. About the VWF.
I actually read it on wiki and the association of aortic stenosis and angiodysplasia is called Hyede's syndrome. Extra knowledge.
 

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Discussion Starter · #5 ·
turbulent flow through stenotic aortic valve disrupts von Willebrand multimers
http://www.educus.com/Journals/23150964

. But, my question to the person who posted it is, I have done u world and they don't have any question with this concept in it. About the VWF.
Q.Id. 4085 in Usmle World.

sometimes doing UW second time is a good idea man.
 

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heyde"s syndrome--- angiodysplasia with aortic stenosis,

vwf is present in areas of sheer stress, such has arond aortic valve because of AS and also in dilated vessels.

vwf multimers gts catabolised by ADAMTS 13 to form active forms...keeps breaking down causing vwf deficiency...
 

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Discussion Starter · #12 ·
okk so this is NEW concept for me..:) Thanks for posting this question
also Microangiopathic Hemolytic anemia is associated with stenotic and
prosthetic valves..right?
prosthetic.
cuz they smash RBC's

also, I haven't seen this in questions, but using a pump while performing CABG leads to hemolysis, bc of rbc's contacting the walls of the pump machine tubes
 
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