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GROUP D MAMBA - MEDENILLA Case 1: Upper GI Bleeding.

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Presentation on theme: "GROUP D MAMBA - MEDENILLA Case 1: Upper GI Bleeding."— Presentation transcript:

1 GROUP D MAMBA - MEDENILLA Case 1: Upper GI Bleeding

2 O.L., 65 y/o, female Chief complaint MELENA

3 History of Present Illness 6 months PTA Vague epigastric discomfort Did not seek consultation Did not take any medication 2 days PTA Present Melena No abdominal pain 10 kg weight loss (past 6 months) 2 episodes of melena (2 cupfuls per episode) 1 episode of coffee-ground vomiting Cold clammy sweats Dizziness

4 Past Medical History Osteoarthritis (5 years ago) Diclofenac Na intermittently  Last intake: 1 week PTA (+) Hypertension, diabetes for 15 years Medications  Losartan, metformin/sitagliptin (Janumet), clopidogrel, simvastatin

5 Physical Examination Vital signs: – BP 120/80 (supine), 100/60 (sitting) – PR 105/min – RR 22/min – Temperature: 37.2°C Weight: 68 kg Height: 160 cm

6 Physical Examination Pale palpebral conjunctiva Anicteric sclera No cervical lymphadenopathy Normal heart and lung sounds Apex beat at 6 th LICS Abdomen Hyperactive bowel sounds Soft, non-tender, no palpable masses, no organomegaly DRE Maroon colored stools

7  Passage of black, tarry, and foul-smelling stools  Caused by a delivery of at least 50 mL of blood into the upper gastrointestinal tract  Degradation of blood to hematin or other hemochromes by bacteria  Blood has been present in the GI tract for at least 14 hours Chief Complaint: MELENA Sleisenger and Fordtran’s Gastrointestinal and Liver Disease, 8 th ed. Harrison’s Principles of Internal Medicine, 17 th ed.

8 APPROACH TO THE PATIENT: Gastrointestinal Bleeding

9 Immediate assessment Stabilization of hemodynamic status Determine the source of bleeding Stop active bleeding Treat underlying abnormality Prevent recurrent bleeding

10 APPROACH TO THE PATIENT: Gastrointestinal Bleeding Immediate assessment  Heart rate  Blood pressure Patient’s Hemodynamic Status (Vital Signs) Blood Loss (% of Intravascular Volume) Severity of Bleed Shock (resting hypotension)20-25Massive Postural (orthostatic hypotension and tachycardia) 10-20Moderate Normal<10Minor Sleisenger and Fordtran’s Gastrointestinal and Liver Disease, 8 th ed.

11 APPROACH TO THE PATIENT: Gastrointestinal Bleeding Resuscitation  Restore and maintain normal vital signs History and physical examination  Preliminary assessment of the site and cause Sleisenger and Fordtran’s Gastrointestinal and Liver Disease, 8 th ed.

12 APPROACH TO THE PATIENT: Gastrointestinal Bleeding Differentiation of upper from lower GIB Upper GIBLower GIB HematemesisHematochezia Melena Hematochezia Hyperactive bowel sounds Elevated BUN Harrison’s Principles of Internal Medicine, 17 th ed.

13 APPROACH TO THE PATIENT: Gastrointestinal Bleeding Differentiation of upper from lower GIB Patient  Melena, hematemesis, and hyperactive bowel sounds Upper GIBLower GIB HematemesisHematochezia Melena Hematochezia Hyperactive bowel sounds Elevated BUN Harrison’s Principles of Internal Medicine, 17 th ed.

14 APPROACH TO THE PATIENT: Gastrointestinal Bleeding Differentiation of upper from lower GIB Patient  Melena, hematemesis, and hyperactive bowel sounds Upper GIBLower GIB HematemesisHematochezia Melena Hematochezia Hyperactive bowel sounds Elevated BUN Harrison’s Principles of Internal Medicine, 17 th ed.


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