Table 85.1The History in Gastrointestinal Bleeding

  1. Identify the probable presence of bleeding
    1. Hematemesis
    2. Melena
    3. Hematochezia
    4. Hypovolemia (syncope, faintness)
  2. Estimate the amount and rapidity of bleeding
    1. Frequency and volume of stools or emesis
    2. Symptoms of hypovolemia
    3. Hematemesis
  3. Ask about site and potential causes
    1. Upper gastrointestinal
      1. Melena and/or hematemesis
      2. Symptoms of peptic ulcer, varices, gastritis, esophagitis, Mallory–Weiss tears, and malignancy
    2. Lower intestinal
      1. Hematochezia
      2. Symptoms of arteriovenous malformations, diverticulosis, cancer, hemorrhoids, inflammatory bowel disease, ischemic colitis
  4. Determine the presence of diseases or situations having poorer prognosis
    1. Congestive heart failure or prior myocardial infarction
    2. Chronic obstructive lung disease
    3. Cirrhosis
    4. Renal failure
    5. Advanced malignancy
    6. Age over 60 years
    7. Clotting disorder

From: Chapter 85, Hematemesis, Melena, and Hematochezia

Cover of Clinical Methods
Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition.
Walker HK, Hall WD, Hurst JW, editors.
Boston: Butterworths; 1990.
Copyright © 1990, Butterworth Publishers, a division of Reed Publishing.

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