Morning report monday august 1 st 2011
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Trivia of the day: Residents of which state got their nickname from the tar seeping out of the ground that became a major product of that state?. Morning Report- Monday, August 1 st 2011. North Carolina “ tarheels ”.

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Morning report monday august 1 st 2011

Trivia of the day: Residents of which state got their nickname from the tar seeping out of the ground that became a major product of that state?

Morning Report- Monday, August 1st 2011


North carolina tarheels
North Carolina “tarheels”

That was for Simone, who gave me the great idea for trivia at the beginning of AM report!!



Initial approach
Initial Approach

  • Step 1: ABCs!! Assess hemodynamic status of the patient

    • Orthostatic changes- best indicator of significant blood loss

  • Step 2: Establish severity of bleeding

    • Coffee ground emesis, melena: lower rate of bleeding

    • Bright red blood: ?higher rate of bleeding


Ugi vs lgi bleeding
UGI vs. LGI Bleeding

  • Step 3: Determine the location of the bleeding

    • UGI: bleeding above the ligament of Treitz

      • Hematemesis

    • LGI: bleeding distal to the ligament of Treitz

      • Bloody diarrhea

      • Bright red blood mixed with or coating stool

    • Hematochezia, melena, or occult blood loss can be due to both UGI or LGI bleeds

      • Passing NGT can determine if the blood is originating from the UGI tract ot LGI tract


Is it blood
Is it Blood?

Simulates Melena

Simulates bright red blood

Bismuth or iron preparations

Spinach

Blueberries

Grapes

Licorice

  • Food coloring

  • Colored gelatin or children’s drinks

  • Red candy

  • Beets

  • Tomato skins

  • Antibiotic syrups


Group assignment
Group Assignment

  • Break into 3 groups:

    • Infant

    • 2-5 years old

    • Older child

  • Come up with a differential diagnosis for lower GI tract bleeding in your age group

    • The “Older child group” has an additional task…since our case is an older child, which diagnosis do you think is most likely and why?



Lgi bleeding in infants
LGI Bleeding in Infants

  • Necrotizing enterocolitis

  • Hirschprungenterocolitis

  • Volvulus/ Intussusception

  • Infectious colitis

  • Anal fissure

  • Eosinophilicproctocolitis

  • Nodular lymphoid hyperplasia

  • Swallowed maternal blood

  • Coagulopathy

  • Allergic colitis



Lgi bleeding in 2 5 year olds
LGI Bleeding in 2-5 year-olds

  • Intussusception

  • Volvulus

  • Henoch-Schonleinpurpura

  • Hemolytic-uremic syndrome

  • Meckeldiverticulum

  • Juvenile polyp

  • Ulcerative colitis/ Crohn’s disease

  • Infectious colitis

  • Nodular lymphoid hyperplasia

  • Perianal streptococcal cellulitis

  • Rectal prolapse/ rectal ulcer



Lgi bleeding in the older child
LGI Bleeding in the Older Child

  • Infectious colitis

  • Ulcerative colitis/ Crohn disease

  • HSP

  • Intestinal ischemia

  • Meckeldiverticulum

  • Juvenile polyp

  • Hemorrhoid



Thanks for your attention
Thanks for your attention!

Noon Conference: Radiology