Q. A 65-year-old comes to the clinic for a review of his symptoms. He has been following up for aortic stenosis for the last 10 years. Over the past three months he has been complaining of fatigue and has lost 8 kg in weight. A full blood count was requested: Hb 9.2 g/dl MCV 65 fl Plt 360 x 10 9 /l WBC 5.0 x10 9 /l Blood film Hypochromic, microcytic picture. An upper GI endoscopy and duodenal biopsy was normal. What is the most appropriate next investigation? A- Transthoracic echocardiogram B- Bone marrow biopsy C- Colonoscopy D- Faecal occult blood E- Mesenteric angiography Answer: C. Colonoscopy Explanation: Patient might be having GI angiodysplasia which can be seen in association with aortic stenosis. This syndrome is known as Heyde's syndrome. Patient presents with anemia due to chronic blood loss. UGI endoscopy is usually normal. Colonoscopy should be next investigation in this case. Definitive treatment is surgical...
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