Topic Info - BotMed Application

TopicName

Upper GI Bleeding

ClinicalTests

CBC (anemia);
Electrolytes;
AST/ALT/ bilirubin/ Alk Phos;
PTT/ INR;

ImagingStudies

Upper endoscopy with biopsy for H.pylori;

PhysicalExams

Vitals – hypotensive, fever;
ENT – lymphadenopathy, erythema of pharynx, ulcerations;
Abdominal – pain on palpation (periumbilical), bowel sounds, guarding, rebound tenderness;
Rectal – lesions, fissures, masses;

Comment

Amount, duration, context (after severe vomiting, alcohol ingestion, nosebleed); associated symptoms (constitutional, nausea, abdominal pain, dyspepsia); medications (especially blood thinners, NSAIDs, and corticosteroids); history of peptic ulcer disease, liver disease, abdominal aortic aneurysm repair, easy bleeding.
Melina: sticky, very nasty-smelling, black stool;

Tachycardia (>15% of blood loss);
Orthostatic hypotension;
Cool clammy skin – risk of hypovolemic shock (30-40% of blood loss);

Iron and Bismuth supplement can cause dark stool!
R/F: Cocaine, Alcohol, Chemotherapy, NSAIDs

WebLink

https://www.aafp.org/afp/2012/0301/p469.html