Archive:Hematemesis: Difference between revisions
wikademia>Koppertone New page: ==DDx== *peptic ulcer disease *gastritis/gastropathy (NSAID, alcohol, stress related) *Mallory-Weiss tear *variceal rupture *erosive esophagitis *foreign object *vascular malformations (Di... |
wikademia>Wikademia m moved Hematemesis to Archive:Hematemesis |
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**epistaxis | **epistaxis | ||
**hemoptysis | **hemoptysis | ||
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==ABCs== | ==ABCs== | ||
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==Impression== | ==Impression== | ||
==Other OSCE modules== | |||
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[[Category: | [[Category: Gastroenterology]][[Category:OSCE]][[Category: Clinical Skills]] | ||
Latest revision as of 08:22, 12 June 2009
DDx
- peptic ulcer disease
- gastritis/gastropathy (NSAID, alcohol, stress related)
- Mallory-Weiss tear
- variceal rupture
- erosive esophagitis
- foreign object
- vascular malformations (Dieulafoy’s lesion, AVMs, aorto-enteric fistula)
- neoplastic disease (esophageal or gastric)
- other
- systemic bleeding disorder
- epistaxis
- hemoptysis
ABCs
- hematemesis can be life threatening
Patient ID, CC
Vomiting
- onset
- precipitant (coughing, forceful vomiting)
- frequency
- characteristics (dry retching and strenuous, protracted)
Vomitus
- volume
- color (bright red, dark red, black)
- properties (coffee grounds - specks of congealed blood, pure blood, mixed with stomach contents)
Accompanying symptoms
- non GI source → epistaxis, hemoptysis, bleeding in gums/mouth, bruising, petechiae
- gastritis → GERD
- Mallory Weiss tear → strenuous or protracted vomiting
- PUD → dysphagia, odynophagia, retrosternal/epigastric discomfort
- varices → jaundice, ascites, generalized edema
- melena → bleeding > 12 hour old
- Anemia (ominous signs)
- orthostatic lightheadedness, dyspnea, fatigue, edema
- pallor, headache
Medications
- NSAID, ASA
- anticoagulants: warfarin, heparin, clopidegrel
PMHx
- prior episodes (diagnosis and outcome)
- PUD → smoking and EtOH
- neoplasm, malnutrition, stress ulcers → systemic illness, recent weight loss, major surgery
Impression
Other OSCE modules
Acute Confusion - Acute Coronary Syndrome Orders - Anemia - Arterial Blood Gasses - Asthma - Blood Pressure - Chest pain - Chest XRay - CHF - Coma - COPD - Cranial Nerves - Diabetic History - Diabetic Foot - Dysphagia - EKGs - Gallbladder and Liver - Liver Disease - Gait and Balance - Headache - Hematemesis - Hypertension - Jugular Venous Pulses - Knee Exam - Lymph Nodes - Community Acquired Pneumonia - Parkinson Disease - Peripheral Arterial Insufficiency - Pneumonia Examination - Precordial Exam - STD's - Spleen - Swollen Leg Exam - Thyroid Exam - Upper vs Lower Motor Neuron Lesions - Urinary Incontinence