Gi bleeding: ugib and lgib are often very concerning for the housestaff caring for the patient, as these entities can be life threatening disorders, especially in the elderly patient with cardiac and possibly other coexisting diseases.   treat this phonecall as a consult , not an order for a study.   this is a complicated, multistep process. 1st step:  calm the house officer and take the patient’s past medical and past surgical and medication history.   demand this information in full , as this will be important to give to the attending when you call him or her, and when considering the patient for angio. viagra 5 mg 10 mg filmtabletten   write this information down. When obtaining the history and physical information, make sure to inquire about the coagulation parameters and cbc (with trends). cheap viagra on line   frequently, these will be supertherapeutic and the cause of the patient’s bleeding. viagra online without prescription   when these are corrected, the bleeding will often stop.   supertherapeutic parameters also limit angio therapy options and effectiveness. generic viagra forum Inquire about any known contrast allergies or renal failure or other contraindications to angiography. Can the patient give consent for angiography?   if not, is there someone else available to give consent?   (if there is no family to consent, 2 physicians outside of the department can consent. generic viagra ) if the patient has been passing blood per rectum, but not at alarming rates continuously, you can relay to the housestaff that the blood which was passed (causing all this franticness) could have been in the large intestine since the last bowel movement. generic viagra online   that said, the nuclear medicine – angiography pathway is designed to detect active bleeding, happening at the time of the examination. lowest price for generic viagra At night, the study we perform is a tc 99m sulfur colloid scan per dr. Bader.   this does not require drawing the patient’s blood for the examination and is slightly quicker to do.   it also does not interfere with a planned tagged rbc study the next day.   the advantages of tc-sc imaging is that the agent is rapidly cleared from the intravascular space by the reticuloendothelial system. order viagra online without script The circulating half-life in patients with normal liver function is between 2-3 minutes, and by 15-20 minutes there is effectively none left in the blood. This permits clear visualization of extravasated isotope at bleeding site. viagra health canada The technique is very sensitive and can detect bleeding rates as low as 0. 05 to 0. 1 cc/min. (angiography realistically requires a bleeding rate of about 1. viagra use dosage 5 to 3 ml/min. viagra health canada To be detected. viagra 20 mg in canada Angiography will detect gi bleeding in 65% of patients when the bleeding rate exceeds 1 ml/min. ) disadvantages tc-sc: prominent liver and spleen activity may obscure the bleeding site. The imaging time is markedly limited (probably no more than 10 minutes). Given the characteristic intermittent nature of gi bleeding, unless the patient is actively blee.  
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