Gastrointestinal Bleeding Tags - Differential Diagnosis of https://ddxof.com/tag/gastrointestinal-bleeding/ A systematic approach to the evaluation and management of various complaints. Fri, 24 Jan 2020 21:42:33 +0000 en-US hourly 1 https://wordpress.org/?v=6.9.1 https://ddxof.com/wp-content/uploads/2017/08/cropped-ddxof@1x-1-32x32.png Gastrointestinal Bleeding Tags - Differential Diagnosis of https://ddxof.com/tag/gastrointestinal-bleeding/ 32 32 46076767 Gastrointestinal Bleeding https://ddxof.com/gastrointestinal-bleeding/ Mon, 14 Dec 2015 08:00:50 +0000 http://ddxof.com/?p=1481 Evaluation and Management of Gastrointestinal Bleeding Key Historical Features Quantity Patient’s estimate Symptoms suggestive of anemia/volume depletion: (pre)syncope, dyspnea Appearance/Location Distinguish upper from lower GI bleding PMH Prior episodes and source History of aortic aneurysm graft Comorbidities: presence of CAD, CHF, liver disease or diabetes increases mortality Medications/substance use Gastrotoxic, anti-coagulants, anti-platelet agents Alcohol abuse... Continue reading →

The post Gastrointestinal Bleeding appeared first on Differential Diagnosis of.

]]> Evaluation and Management of Gastrointestinal Bleeding

Evaluation and Management of Gastrointestinal Bleeding

Key Historical Features

Quantity
Patient’s estimate
Symptoms suggestive of anemia/volume depletion: (pre)syncope, dyspnea
Appearance/Location
Distinguish upper from lower GI bleding
PMH
Prior episodes and source
History of aortic aneurysm graft
Comorbidities: presence of CAD, CHF, liver disease or diabetes increases mortality
Medications/substance use
Gastrotoxic, anti-coagulants, anti-platelet agents
Alcohol abuse

Key Physical Findings

Vital signs
Tachycardia or hypotension
Eyes
Conjuntival pallor suggests anemia
Scleral icterus suggests liver disease
Abdomen
Hyperactive bowel sounds may be present in UGIB (blood is cathartic)
Epigastric tenderness to palpation suggests PUD
Diffuse tenderness suggests bowel ischemia, obstruction/ileus, or perforation
Rectal (digital, anoscopy)
May reveal fissures, hemorrhoids or polyps

Labs/Diagnostic Tests

  • CBC: consider transfusion for Hb <8-10g/dL particularly in elderly or those with CAD
  • BMP: BUN:creatinine > 36 in the absence of renal failure suggests UGIB
  • PT/PTT/INR: coagulopathy
  • Lactate: elevated in bowel ischemia or systemic hypoperfusion
  • T&S or T&C
  • ECG: screen for myocardial ischemia

Blatchford Scoring System

Item Value Points
BUN 18-22 2
22-28 3
28-70 4
>70 6
Hb (male) 12-13 1
10-12 3
<10 6
Hb (female) 10-12 1
<10 6
SBP 100-109 1
90-99 2
<90 3
Other HR > 100 1
Melena 1
Syncope 2
Liver disease 2
Heart failure 2

References:

  1. Goralnick, E., & Meguerdichian, D. (2013). Gastrointestinal Bleeding. In Rosen's Emergency Medicine – Concepts and Clinical Practice (8th ed., Vol. 1, pp. 248-253). Elsevier Health Sciences.

The post Gastrointestinal Bleeding appeared first on Differential Diagnosis of.

]]> 1481