question archive In the emergency department, a 71-year-old patient complains of rectal bleeding
In the emergency department, a 71-year-old patient complains of rectal bleeding
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In the emergency department, a 71-year-old patient complains of rectal bleeding. Her initial episode was red some six hours before, when she passed red blood and clots. Initially she attributed the bleeding to her hemorrhoids, but since then she has had five additional episodes, the last of which was followed with a sense of dizziness. She doesn't smoke or consume alcoholic drinks. She consumes a few aspirin a day to manage arthritis. Physical inspection shows a lady who's weak/pale and nervous.
BP (supine position) = 110/70 mmHg
Pulse (supine position) = 100 beats/min
BP (standing) = 85/50 mmHg
Pulse (standing) = 130 beats/min
Abdominal evaluation did not show any suspicious finds. The rectal assessment shows red blood in the vault and no mass.
What are 3 likely potential explanations for the hematochezia of the patient?
What kind of therapeutic/diagnostic things we have to conduct in the first hour?
What therapeutic/diagnostic tests we have to conduct over the next 24-48 hours?
A 43-year-old man is transported to the emergency department of the local hospital, following an episode of hematemesis and a syncope in a nearby pub. He didn't have any prior GI bleeding. He routinely uses aspirin to relieve chronic back pain. He passes a few liquid, maroon stools during the interview. Physical testing indicates supine blood pressure and pulse of 120/75 mmHg and 110 beats per minute. Once you let him sit straight, he reports about feeling dizzy and his systolic pressure decreases to 90 m Hg of palpation. His belly is swollen and distended. Shifting dullness is caused and the tip of the spleen is palpable. The preliminary hemoglobin is 15 g/dL and the hematocrite is 45%.
So how would we know that this person has lost a lot of blood? What are the most potential explanations of this person's upper GI bleeding, as well as what will be the next clinical step?
A 51-year-old male has recurring and occasionally serious epigastric stomach discomfort over the last few years. Antacids gave him symptomatic comfort. The latest episode started one week back and did not fully respond to antacids. The discomfort is now waking him up at night. He smokes 1 pack of cigarettes a day, and consumes aspirin a couple days per week. Family background is extraordinary, so no genetic issues. Physical inspection shows mild epigastric tenderness with no signs of mass. The stool is brown and is positive about blood.
Peptic ulcer's disease risk factors for this individual? What type of diagnostic tests? When can we perform therapy for H pylori?
