| Hematemesis | |
| Melena | |
| Hematochezia | |
| Occult bleeding |
| 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 |
| Differential diagnosis is extensive | ||
| Major causes; | ||
| PUD | ||
| Esophageal/Gastric Varices | ||
| Esophagitis | ||
| Mallory-Weiss tear | ||
| Anal and rectal lesions | |
| Colonic lesions | |
| Diverticula |
| 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 |
| Orthostatic changes in pulse & BP | |
| Cardiopulmonary | |
| Skin | |
| Examine oral cavity & nasopharynx | |
| Lymph nodes | |
| Abdomen | |
| Digital rectal |
| 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 |