Melena

HISTORY:

Melena for ‍ ‍hoursdays

Type: ‍darkblack, ‍stickytarry stools, ‍strong foul smell

Occurred ‍ times ‍per dayoverall

‍abdominal pain, ‍diffuse, ‍dull, ‍mild

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍

‍hematemesis

‍weakness

‍fatigue

‍dizziness

‍fainting

‍shortness of breath

‍chest pain, ‍retrosternal, ‍on exertionat restwith deep breath

‍hematemesis

‍weight loss, ‍ ‍lbskg over ‍ ‍weeksmonths, ‍unintentionalintentional



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normallymphadenopathy

Heart: ‍RRR, ‍normal S1 and S2

Lungs: ‍clearabnormal sounds, ‍retractions

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

Extremities: ‍edema, ‍warm, cap refill ‍< 3 sec> 3 sec, pulses ‍normal, ‍



ASSESSMENT:

‍Upper gastrointestinal bleeding ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Blood work: ‍CBC, ‍CRP, ‍electrolytes, ‍creatinine, ‍LFTs, ‍ferritin, ‍coagulation profile, ‍H. pylori serology

- H. pylori breath test

- Upper GI endoscopy

- Colonoscopy

- Abdominal ultrasound

- CT scan of abdomen and pelvis

- IV fluids

- ‍IV anti-acids

- ‍Oral PPIs

- Stop NSAIDs

- Stop anticoagulants

- Increase fluid intake

- Referral to gastroenterologist

- Referral to general surgeon

- Follow-up in ‍ ‍daysweeks

- Return if bleeding worsens, if new symptoms develop such as abdominal pain or weight loss, or if symptoms do not improve with treatment

- Go to ER if severe abdominal pain, fever, or hemodynamic instability occurs