Case 1: Upper GI Bleeding

1. Case 1: Upper GI Bleeding Group D Mamba - Medenilla

2. Case 1: Upper GI Bleeding • O.L. , 65 y/o, female • Chief complaint • MELENA

3. History of Present Illness • 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 6th LICS • Abdomen • Hyperactive bowel sounds • Soft, non-tender, no palpable masses, no organomegaly • DRE • Maroon colored stools

7. Chief Complaint:MELENA 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 Sleisenger and Fordtran’s Gastrointestinal and Liver Disease, 8th ed. Harrison’s Principles of Internal Medicine, 17th ed.

8. APPROACH TO THE PATIENT:Gastrointestinal Bleeding

9. APPROACH TO THE PATIENT:Gastrointestinal Bleeding • 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 Sleisenger and Fordtran’s Gastrointestinal and Liver Disease, 8th 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, 8th ed.

12. APPROACH TO THE PATIENT:Gastrointestinal Bleeding • Differentiation of upper from lower GIB Harrison’s Principles of Internal Medicine, 17th ed.

13. APPROACH TO THE PATIENT:Gastrointestinal Bleeding • Differentiation of upper from lower GIB • Patient • Melena, hematemesis, and hyperactive bowel sounds Harrison’s Principles of Internal Medicine, 17th ed.

14. APPROACH TO THE PATIENT:Gastrointestinal Bleeding • Differentiation of upper from lower GIB • Patient • Melena, hematemesis, and hyperactive bowel sounds Harrison’s Principles of Internal Medicine, 17th ed.