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GASTROINTESTINAL BLEEDING

CLINICAL PRESENTATION. Clinical manifestations of GI bleeding depends upon extent

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GASTROINTESTINAL BLEEDING

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    1. GASTROINTESTINAL BLEEDING Hematemesis Melena Hematochezia Occult bleeding

    2. 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

    3. ETIOLOGY OF UGI BLEEDING Differential diagnosis is extensive Major causes; PUD Esophageal/Gastric Varices Esophagitis Mallory-Weiss tear

    4. ETIOLOGY OF LOWER BLEED Anal and rectal lesions Colonic lesions Diverticula

    5. 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

    6. PHYSICAL Orthostatic changes in pulse & BP Cardiopulmonary Skin Examine oral cavity & nasopharynx Lymph nodes Abdomen Digital rectal

    7. DIAGNOSTIC TESTS CBC PT, PTT Other lab tests relevant to physical findings Upper endoscopy if stable Colonoscopy

    8. 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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