Upper GI bleeding

Question 1

Key history in upper GI bleeding

Answer 1

Amount, duration, context (after severe vomiting, alcohol ingestion, nosebleed)
Other symptoms (constitutional, nausea, abdominal pain, dyspepsia)
Medications (especially blood thinners, NSAIDs and corticosteroids)
Hx of peptic ulcer disease, liver disease, AAA repair, easy bleeding

Question 2

Key physical exam in upper GI bleeding

Answer 2

Vital signs, including orthostatics

ENT, heart, lung, abdominal and rectal exams

Question 3

45 yo F with coffee-ground emesis over last three days
+ dark and tarry stool
+ Hx of intermittent epigastric pain relieved by food and antacids

Answer 3

Bleeding peptic ulcer
Gastritis
Gastric cancer
Esophageal varices

Rectal exam, CBC, type and cross, electrolytes, AST/ALT/bilirubin/alkaline phosphatase, INR, upper endoscopy (including H. pylori testing if ulcer is confirmed)

Question 4

40 yo F with epigastric pain and coffee-ground emesis
+ Hx of rheumatoid arthritis treated with aspirin
+ alcoholic

Answer 4

Gastritis
Bleeding peptic ulcer
Gastric cancer

Rectal exam, CBC, type and cross, electrolytes, AST/ALT/bilirubin/alkaline phosphatase, INR, upper endoscopy (including H. pylori testing if ulcer is confirmed)