GROUP D MAMBA - MEDENILLA Case 1: Upper GI Bleeding.
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Transcript of GROUP D MAMBA - MEDENILLA Case 1: Upper GI Bleeding.
GROUP DMAMBA - MEDENILLA
Case 1: Upper GI Bleeding
Case 1: Upper GI Bleeding
O.L. , 65 y/o, female
Chief complaint• MELENA
History of Present Illness
• 2 episodes of melena (2 cupfuls per episode)• 1 episode of coffee-ground vomiting
•Cold clammy sweats•Dizziness
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
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
Physical Examination
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, 8th ed.Harrison’s Principles of Internal Medicine, 17th ed.
APPROACH TO THE PATIENT:Gastrointestinal Bleeding
APPROACH TO THE PATIENT:Gastrointestinal Bleeding
Immediate assessmentStabilization of hemodynamic statusDetermine the source of bleedingStop active bleedingTreat underlying abnormalityPrevent recurrent bleeding
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) 20-25 Massive
Postural (orthostatic hypotension and tachycardia)
10-20 Moderate
Normal <10 MinorSleisenger and Fordtran’s Gastrointestinal and Liver Disease, 8th ed.
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, 8th ed.
APPROACH TO THE PATIENT:Gastrointestinal Bleeding
Differentiation of upper from lower GIBUpper GIB Lower GIB
Hematemesis Hematochezia
Melena
Hematochezia
Hyperactive bowel sounds
Elevated BUN
Harrison’s Principles of Internal Medicine, 17th ed.
APPROACH TO THE PATIENT:Gastrointestinal Bleeding
Differentiation of upper from lower GIB
Patient Melena, hematemesis, and hyperactive bowel
sounds
Upper GIB Lower GIB
Hematemesis Hematochezia
Melena
Hematochezia
Hyperactive bowel sounds
Elevated BUN
Harrison’s Principles of Internal Medicine, 17th ed.
APPROACH TO THE PATIENT:Gastrointestinal Bleeding
Differentiation of upper from lower GIB
Patient Melena, hematemesis, and hyperactive bowel
sounds
Upper GIB Lower GIB
Hematemesis Hematochezia
Melena
Hematochezia
Hyperactive bowel sounds
Elevated BUN
Harrison’s Principles of Internal Medicine, 17th ed.