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Approach to Hematemesis and Melena

Approach to Hematemesis and Melena . 6 th Year Medicine Dr Yasir M Khayyat Assistant Professor/Gastroenterologist. Management Outline . A irway  B reathing  C irculation  D ecide on A d mission . Causes of UGIB ( Hematemesis/Melena). Melena: passage of black

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Approach to Hematemesis and Melena

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  1. Approach to Hematemesis and Melena 6th Year Medicine Dr Yasir M Khayyat Assistant Professor/Gastroenterologist

  2. Management Outline Airway  Breathing  Circulation  Decide on Admission

  3. Causes of UGIB ( Hematemesis/Melena)

  4. Melena: passage of black Tarry offensive stool due to Bleeding form the upper GIT proximal to ligmant of Tretiz ( > 100 ml). Basic Mechanisms: • Hyperacidity • H pylori • Vascular anomalies • Autoimmune • Malignancy Ligament of Treitz

  5. Endoscopic Diagnosis

  6. Take home message • Always think of hemodynamic stability ABC • Then think to do H & P • Common things are common • Careful not to kill the patient and know when to call for somebody help • Common diseases are peptic ulcers, liver disease, drug induced and malignancy. • Decide if you admit ( ward/ICU) or discharge.

  7. Approach to Diarrhea

  8. Diarrhea : • Increased frequency or stool Weight ( > 200g) or frequency ( ≥ 3 BM/d) Onset: Acute: < 4 weeks Chronic : > 4 weeks

  9. Basic Pathologic Mechanisms

  10. Now think of the causes of diarrhea and mention 4 causes under each category ( Acute vs. chronic) 1- 2- 3- 4- 1- 2- 3- 4- 1- 2- 3- 4- 1- 2- 3- 4-

  11. General approach to Diarrhea History: • Normal bowel habits • Onset: sudden/chronic • Frequency, Food relation • Stool appearance, Smell • Drugs • Tenesmus • Travel. Contact • Stress • Associated features • Nocturnal diarrhea • Thyrotoxicosis Physical Examination: • Vital signs: • Volume status/Dehydration: • Eyes : anemia,thyrotoxicosi • Skin: flushing, rashes • L.N: • Abdomen: mass,distension,tenderness, • Hands: clubbing

  12. Investigations: • CBC:WBC (…….),Hb (……..),Plt (……….),INR ?why • Serum Electrolytes, (BUN , Creatinine ),Album • Stool :analysis, O & P, Culture, ?Fat ,Occult blood. Clostridium difficle,24 hr fat>10g( malabsorption),Osmolality and gap ? • Specialized Tests: Endoscopy ( U & L) • DM : FBS,RBS • Thyroid : TSH,Ft3,Ft4 • Malabsorption: Folate, Vit B12,Iron, serum gastric,VIP,Calcitonin,Cortisol,5 HIAA (for what?)

  13. Outline of Diarrhea management • Assure ABC as always, assess volume status and replace lost fluids and electrolyte ( Na,K,Cl,HCO3) • Antimotility : Loperamide,Atropine ( careful) • Antibiotics : not for everybody, Gram negative,parasites,anaerobes • Prevention of spread, identification of the source • Treat the underlying cause of inflammatory, Secretory chronic diarrhea.

  14. Take home message • Think of the patient ( immunocompetent/Immunocompromised) • Back to the basics ( city, Incubation period, types of culture and Investigations) • DO NOT GIVE ANTIBIOTICS TO ALL DIARRHEA . • Antimicrobials are not the only thing that the patient need ( hydration,shock,renal/liver.F) • GO home and Read ???

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