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GI Bleeding Case Study
History: The patient is
a 63-year-old African-American gentleman with history of
hypertension, questionable history of CHF, and history of alcohol
abuse who presented to the emergency department with a two-day
history of periumbilical pain and dark maroon and black stools.
He reported four to five of these stools the day prior to admission
as well as the day of admission. He denied any hematemesis.
Pain started at about the same time that he started having bloody
movements. He does report he drinks half-a-pint of whiskey per
day and has done this for many years. He has used occasional
naproxen one to two times a week. He smokes half-a-pack per
day for several years. No other drug use.
Family History: Positive
for colon cancer and prostate cancer.
Medications: Clonidine,
Lisinopril, Lasix, Atenolol, Plavix, & Potassium Chloride
Physical Exam: Heart
rate 114, Blood pressure 129/74. Guaiac positive
Hospital Course:
Patient was
initially started on IV hydration, but continued to have episodes of
bleeding and was transferred to the MICU. He was transfused a total
of five units of packed red blood cells during the first 24 hours
due to a hemoglobin drop from 12 to 7. Patient continued to be
hypotensive but corrected with normal saline boluses and no required
pressors. GI was consulted. EGD and colonoscopy were done that
showed no evidence of active bleeding, but post exam patient
continued to have a drop in his hemoglobin and hematocrit.
Patient went for a bleeding scan that showed actively bleeding area
in the third portion of his duodenum. GI was informed of the
findings and repeat EGD was done. They were able to get to the
third part of the duodenum, and a bleeding ulcer was found and
cauterized by endoscopy. Patient was transfused three further units
of packed red blood cells due to continued decrease in H and H.
Patient was transferred out of the unit after his H and H were
stable, with no further episodes of GI bleeding. Patient remained
on the floor and repeat H and H q.6h. remained stable. Patient had
no complaints and requested to be discharged home. While inpatient
he was also started on H. pylori treatment with amoxicillin,
clarithromycin, and PPI (proton pump inhibitor). The patient is to
be discharged home on H. pylori treatment and b.i.d. PPI.
Nuclear Medicine Report:
BLOOD LOSS STUDY
CLINICAL HISTORY: 63-year-old male with a history of lower GI
bleeding and melena. This study is requested for evaluation for
bleed.
TECHNIQUE: Autologous red blood cells with labeled in vitro with
approximately 24 mCi of Tc 99 pertechnetate. Following injection,
dynamic images were obtained over the abdomen for 90-minutes. The
images were reviewed and CINE display was also examined.
FINDINGS: Physiologic activity is seen in the liver, spleen and
great vessels. Focal accumulation was identified at approximately
the third segment of the duodenum with reflux up to if not into the
stomach. Antegrade flow and pooling was seen at the first part of
the ilium.
IMPRESSION:
FOCAL ACCUMULATION SUGGESTIVE OF BLEEDING AT APPROXIMATELY THE THIRD
PORTION OF THE DUODENUM.
Alcohol and gastrointestinal bleeding. Pub Med
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2226291&dopt=Abstract
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© 2006 Nuclear Education Online
- Images courtesy of University
of Arkansas for Medical Sciences Dept of Nuclear Medicine.
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