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Hematemesis Melena Hematochezia Occult Bleeding

This document discusses gastrointestinal bleeding, including common causes and symptoms. It outlines the clinical presentation depending on the extent and rate of bleeding. The etiology of upper and lower GI bleeding is described, including major causes such as peptic ulcer disease, esophageal/gastric varices, and colonic lesions. The importance of considering factors that could cause a false positive fecal occult blood test is highlighted. Physical exam findings and appropriate diagnostic tests are also summarized, along with indications for admission or referral.

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280 views8 pages

Hematemesis Melena Hematochezia Occult Bleeding

This document discusses gastrointestinal bleeding, including common causes and symptoms. It outlines the clinical presentation depending on the extent and rate of bleeding. The etiology of upper and lower GI bleeding is described, including major causes such as peptic ulcer disease, esophageal/gastric varices, and colonic lesions. The importance of considering factors that could cause a false positive fecal occult blood test is highlighted. Physical exam findings and appropriate diagnostic tests are also summarized, along with indications for admission or referral.

Uploaded by

dg_doc
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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GASTROINTESTINAL

BLEEDING

• Hematemesis
• Melena
• Hematochezia
• Occult bleeding
CLINICAL PRESENTATION

• Clinical manifestations of GI bleeding


depends upon extent & rate
• Postural hypotension suggests acute
hemorrhage & intravascular volume
depletion
• Fatigue & exertional dyspnea typical
symptoms with slow, chronic blood loss
ETIOLOGY OF UGI BLEEDING

• Differential diagnosis is extensive


• Major causes;
– PUD
– Esophageal/Gastric Varices
– Esophagitis
– Mallory-Weiss tear
ETIOLOGY OF LOWER BLEED

• Anal and rectal lesions


• Colonic lesions
• Diverticula
HISTORY
• Consider factors that may cause false + FOBT
• Postural hypotension helps determine need for
hospitalization
• H/O PUD, recent use of NSAIDs
• Weight loss & change in bowel habits
• H/O liver disease, ETOH abuse, inflammatory
bowel disease
PHYSICAL

• Orthostatic changes in pulse & BP


• Cardiopulmonary
• Skin
• Examine oral cavity & nasopharynx
• Lymph nodes
• Abdomen
• Digital rectal
DIAGNOSTIC TESTS

• CBC
• PT, PTT
• Other lab tests relevant to physical findings
• Upper endoscopy if stable
• Colonoscopy
INDICATIONS FOR
ADMISSION & REFERRAL
• Admit pts with h/o recent brisk bleeding &
orthostatic changes
• Admit pts with less sever blood loss who have
comorbid conditions aggravated by anemia
• Profound anemia with no evidence of blood loss
• Refer pts who are candidate for endoscopy or
colonscopy when source of bleeding is elusive

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