Dark-Tarry Stools

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of melena

Described as ‍darkblack, ‍stickytarry stools, ‍strong foul smell

Occurred ‍ times ‍per dayoverall



Associated symptoms: *Try using right-click for negatives*

‍abdominal pain, ‍diffuse, ‍dull, ‍mild

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍weakness

‍fatigue

‍dizziness

‍fainting

‍shortness of breath

‍chest pain, ‍retrosternal, ‍aching, ‍on exertionat restwith deep breath, ‍mild

‍hematemesis

‍weight loss, ‍ ‍lbskg over ‍ ‍weeksmonths, ‍unintentionalintentional



Contributing factors:

‍heavy drinker

‍recent blueberry eating

no history of: ‍peptic ulcer disease, ‍chronic liver disease esophageal varices

no use of: ‍anticoagulants, ‍antiplatelets, ‍NSAIDs, ‍iron supplements

no family history of: ‍gastric or colon cancer





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

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

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Anorectal: DRE ‍normal, prostate ‍normal, ‍blood, ‍mass, anus ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍





ASSESSMENT:

‍Upper gastrointestinal bleeding ‍likelysuspectedpossible

DDx: upper gastrointestinal bleeding, lower gastrointestinal bleeding, peptic ulcer disease, gastric erosions, gastric cancer, esophageal varices, Mallory-Weiss tear, duodenal ulcer, angiodysplasia, Dieulafoy's lesion, medication-induced gastrointestinal bleeding (e.g., NSAIDs, anticoagulants), coagulopathy, inflammatory bowel disease, intestinal ischemia, right-sided colon cancer, Meckel's diverticulum, iron supplement, blueberry intake, aortoenteric fistula, infectious enterocolitis, radiation enteritis, vascular malformations, diverticulosis





PLAN:

Investigations:

- 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

Treatments:

- IV fluids

- ‍IV anti-acids

- ‍Oral PPIs

- Stop NSAIDs

- Stop anticoagulants

- Increase fluid intake

Further care:

- 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

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