Upper GI Bleeding

Question 1

What key history would you obtain for a patient with an upper GI bleed?

Answer 1

Amount
Duration
Context (after severe vomiting, alcohol ingestion, nosebleed)
Associated symptoms (constitutional, nausea, abdominal pain, dyspepsia)
Medications (warfarin, NSAIDs)
History of peptic ulcer disease, liver disease, abdominal aortic aneurysm repair, easy bleeding

Question 2

What key physical exams would you perform on a patient with upper GI bleeding?

Answer 2

Vital signs including orthostatics
ENT
Heart, lung, abdominal and rectal exam

Question 3

45 yo F presents with coffee-ground emesis for the last three days. Her stool is dark and tarry. She has a history of intermittent epigastric pain that is relieved by food and antacids. Differentials?

Answer 3

Bleeding peptic ulcer
Gastritis
Gastric cancer
Esophageal varices

Question 4

45 yo F presents with coffee-ground emesis for the last three days. Her stool is dark and tarry. She has a history of intermittent epigastric pain that is relieved by food and antacids. Differentials: bleeding peptic ulcer, gastritis, gastric cancer, esophageal varices. Workup?

Answer 4

Rectal exam
CBC, electrolytes
AST/ALT/bilirubin/alkaline phosphatase
Endoscopy (including H. pylori testing if ulcer is confirmed)

Question 5

40 yo F presents with epigastric pain and coffee-ground emesis. She has a history of rheumatoid arthritis that has been treated with aspirin. She is an alcoholic. Differentials?

Answer 5

Gastritis
Bleeding peptic ulcer
Gastric cancer
Esophageal varices
Mallory-Weiss tear

Question 6

40 yo F presents with epigastric pain and coffee-ground emesis. She has a history of rheumatoid arthritis that has been treated with aspirin. She is an alcoholic. Differentials: gastritis, bleeding peptic ulcer, gastric cancer, esophageal varices, Mallory-Weiss tear. Workup?

Answer 6

Rectal exam
CBC, electrolytes
AST/ALT/bilirubin/alkaline phosphatase
Barium swallow
Endoscopy