Case #2 Answers:

Answer 1
Initial management is resuscitation of the patient. History is that of painless hematochezia which indicates a lower GI bleeding source. Normal BUN/creatinine also point to lower source.

Answers 2 & 3
Differential diagnosis in this patient includes diverticulosis and arteriovenous malformations. Colon cancer is also a consideration especially with the family history. Inflammatory bowel disease less likely.

Answer 4
Patient should be admitted, resuscitated, and prepped for colonoscopy. If negative for bleeding source then upper GI endoscopy is needed as well as a small bowel series for complete evaluation of the GI tract.

Answers 5 & 6
If bleeding is a continued problem, then angiography should be considered. Nuclear Medicine bleeding scans, although good in theory, rarely are helpful in the GI bleeder. Surgery is an alternative in the persistent bleeder with AVM’S or diverticulosis.