An old female with Recurrent Malena

A female aged 75 years Chief Complaints Recurrent malaena (on/off) (x 20 days) Pain lower abdomen Physical Examination Mild tenderness in lower abdomen Investigations UGIE - Normal Sigmoidoscopy - On retroflexion in the rectum, following was noted

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Diagnosis could be of factor XIII (FXIII) deficiency. For patients older than 40 years, vascular lesions, erosions, or ulcer related to nonsteroidal anti-inflammatory drugs are common causes of obscure gastrointestinal bleeding... Fresh frozen plasma infusion, and at 1 year of follow-up, pt will be well improved.

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Retroflexion in rectum shows grade II hemorrhoids Hemorrhoids caused fresh bleeding per rectum, which of red in colour This patient has maleena which is black in colour, it is usually caused by bleeding source in proximal colon or small intestine Therefore, in this case cause of maleena need to be further investigated Adv Piles banging for hemorrhoids Complete colonoscopy followed by capsule endoscopy to look for cause of maleena

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CAUSES OF RECURRENT MAKENA ARE 1 PEPTIC ULCER DESEASE 2 LIVER DESEASE 3 GASTRITIS CARCINOMA

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Metamorphosis of sigmoidal mucosa Malignant lesion ?Ca sigmoid Adv biopsy

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Malignancy of Bowel should be ruled out. By CTAbdomen snd Biopsy if growth is seen.

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Ad biopsy to confirm the diagnosis

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Malignancy of Bowel should be ruled out

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