Question of the Week # 337

337) A 62 year old man with past medical history of hypertension is admitted with bright red bleeding per rectum. He has no pain.  He had four other episodes of bright red bleeding in the past one year. All the episodes were painless. He refused colonoscopy at that time. He denies any constipation or diarrhea. He reports no weight-loss. He denies any chest pain or shortness of breath. On physical examination, his vitals are stable. Cardiovascular examination reveals a 4/6 early peaking systolic murmur that radiates to his neck and the carotids. Reminder of his exam is benign. The patient agrees for endoscopic evaluation and is scheduled for Colonoscopy. Which of the following is most likely to be diagnosed on Colonoscopy?

A) Ischemic Colitis

B) Colon cancer

C) Diverticulosis

D) Arterio-Venous Malformations

E) Internal Hemorrhoids

12 Responses

  1. D) Arterio-Venous Malformations

    Heyde Syndrome – Aortic stenosis associated with gi bleed due to av malformation

  2. E, painless bright red bleeding per rectum in episodes. the systolic murmur (of aortic stenosis) is a distraction

  3. option B,colon cancer

  4. D

  5. D

  6. D rectal bleeding from from arteriole-venous malformation which is associated with aortic stenosis

  7. thanks shru, i didnt know about Heyde syndrome,my knowledge increases because of you.
    offcourse its D.

  8. D: I don’t know Heyde’s syndrome before. thank you very much Dr RED. Your questions are very interesting.

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