Differential Diagnosis for Massive Lower GIT Bleeding in a 67 y.o Male
Single Most Likely Diagnosis
- Diverticulosis (B): This is the most common cause of lower gastrointestinal bleeding in adults over 60 years old. The patient's age and history of chronic constipation increase the likelihood of diverticulosis. Although the question suggests Angiodysplasia (A) as the chosen answer, Diverticulosis is more common and thus should be considered the single most likely diagnosis.
Other Likely Diagnoses
- Angiodysplasia (A): This condition involves vascular malformations in the gastrointestinal tract and is a common cause of lower GI bleeding, especially in the elderly. The use of anticoagulants like Clodrel (clopidogrel) for ischemic heart disease (IHD) increases the risk of bleeding from angiodysplasia.
- Colonic Cancer (C): Although less common than diverticulosis as a cause of lower GI bleeding, colonic cancer is a significant consideration, especially in older adults. Chronic constipation could be a symptom, but it's more commonly associated with other factors.
- Peptic Ulcer Disease (D): While more commonly associated with upper GI bleeding, peptic ulcers can occasionally cause lower GI bleeding, especially if the ulcer is located in the duodenum or stomach and erodes into a nearby vessel.
Do Not Miss Diagnoses
- Haemorrhoids (E): Although typically causing less severe bleeding, hemorrhoids can occasionally lead to significant bleeding, especially if they are large or if there is a coagulopathy due to anticoagulant use like Clodrel.
- Ischemic Colitis: This condition, caused by reduced blood flow to the colon, can lead to bleeding and is critical to diagnose early to prevent complications. It might not be as common but is crucial not to miss due to its potential severity.
Rare Diagnoses
- Meckel's Diverticulum: A congenital anomaly of the small intestine that can cause bleeding, usually in younger patients but can be considered in the differential diagnosis of lower GI bleeding in any age group.
- Intussusception: A condition where a part of the intestine telescopes into another part, which can cause bleeding and obstruction. It's rare in adults but can occur, often associated with a lead point like a tumor.
- Vascular Malformations (other than Angiodysplasia): Other vascular anomalies can cause GI bleeding, including Dieulafoy's lesion or blue rubber bleb nevus syndrome, though these are less common.
The choice of Angiodysplasia over Diverticulosis might be based on specific clinical clues not provided in the question, such as the presence of anticoagulant use (Clodrel) which increases the risk of bleeding from angiodysplasia, or specific endoscopic findings. However, based on prevalence alone, Diverticulosis would typically be considered the most likely cause of massive lower GI bleeding in a 67-year-old male.