Instinct is Learned

Mr. Reynolds is a vivid 83 year old who lived alone at home. He walks everyday int he morning first thing before he has a small cup of coffee. His kids bought him an ipad and he uses it to browse the Washington Post, the Wall Street Journal, and the Pittsburgh Post Gazette while eating breakfast. Every morning it’s the same breakfast…toast with honey and a small cup of yogurt. Then he’s ready to start the day, just when the rest of his neighbors are waking up. Today however, he ate hist toast and his stomach grumbled, louder than usual.  He thought to himself that he’d better get to the bathroom quickly… and he was right. I met him an hour later in a gurney with the chief complaint of ‘bloody diarrhea’.   He looked great to me, comfortable, normal blood pressure and heart rate, he wasn’t pale, no pain at all. The only finding was maroon colored stool. I sent off a bunch of labs thinking he had one of 3 main intestinal related issues…bleeding ulcer, bleeding polyp / diverticula, or hemorrhoids.  Hemorrhoids were less likely since the blood is usually bright red.  Likewise lower intestinal bleeding is often still bright red since there’s a short distance for it to travel and the bright red color is maintained.  Hmm…that leaves a bleeding ulcer from the stomach.  int he stomach the blood is exposed to stomach acid, which turns the iron black.  Black stool is a bad sign..but maroon stool is even more ominou...
Source: Mr. Hassle's Long Underpants - Category: Emergency Medicine Authors: Tags: Clinical Source Type: blogs