Hello and welcome.
Today we will discuss the approach to the
patient with a gastrointestinal bleed.
So, we'll begin with a case.
Mr. Gibb is a 56-year-old
man with chronic knee pain
who presents to the emergency department
with 2 days of coffee ground emesis.
He complains of dull
epigarstric pain and nausea.
He takes 800 mgs of ibuprofen
3 times a day for knee pain.
He drinks 3 to 6 beers a day.
His only medications are baby
aspirin, metoprolol and ibuprofen.
His vitals show a temperature
of 37, blood pressure of 89/55,
heart rate: 106 and saturation
of oxygen 98% on room air.
His physical exam reveals
and tenderness to palpation in the epigastric
region without rebound or guarding.
A nodular liver edge is palpated
5 cm below the costal margin.
His hemoglobin is 11 from a prior value of
14 and platelets are normal, his INR is 1.2.
So we are asked, what is the
best next step in management?
Before we answer that question, let's
get to some key features in this case.
So, his symptoms of coffee ground emesis with dull
epigastric pain are some of the concerning GI symptoms.
In addition, we know that he has
frequent NSAID use and alcohol use.
If we look closely at his vital
signs and his physical exam,
we know that he has some signs that are
concerning for hypovolemia, he has anemia,
and some localizing symptoms on his exam
that may help us with our differential.
Now let's look at
This is quite low for a normal
adult, male would be from 14 to 18.
So he is anemic and we'll
discuss what that means.