Sandbox: manpreet kaur: Difference between revisions
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Obtaining the history is the most important aspect of making a [[diagnosis]] of upper [[Gastrointestinal tract|GI]] [[bleed]]. It provides insight into the [[Causality|cause]], precipitating factors and associated [[comorbid]] conditions and also helps in determining the severity of the [[bleed]] as well as in identifying the [[potential]] source of [[bleed]]. Patients may be [[Disorientation|disoriented]], therefore, the patient interview may be difficult. In such cases, history from the care givers or the family members may need to be obtained. <ref name="pmid25400991">{{cite journal |vauthors=Kim BS, Li BT, Engel A, Samra JS, Clarke S, Norton ID, Li AE |title=Diagnosis of gastrointestinal bleeding: A practical guide for clinicians |journal=World J Gastrointest Pathophysiol |volume=5 |issue=4 |pages=467–78 |year=2014 |pmid=25400991 |pmc=4231512 |doi=10.4291/wjgp.v5.i4.467 |url=}}</ref><ref name="pmid23547576">{{cite journal |vauthors=Bull-Henry K, Al-Kawas FH |title=Evaluation of occult gastrointestinal bleeding |journal=Am Fam Physician |volume=87 |issue=6 |pages=430–6 |year=2013 |pmid=23547576 |doi= |url=}}</ref> | |||
===Past Medical History=== | |||
*A history of [[epigastric pain]], [[dyspepsia]], or prior [[peptic ulcer]] may suggest the [[Diagnosis-related group|diagnosis]] of [[peptic ulcer disease]].<ref name="LaineSolomon2016">{{cite journal|last1=Laine|first1=Loren|last2=Solomon|first2=Caren G.|title=Upper Gastrointestinal Bleeding Due to a Peptic Ulcer|journal=New England Journal of Medicine|volume=374|issue=24|year=2016|pages=2367–2376|issn=0028-4793|doi=10.1056/NEJMcp1514257}}</ref> | |||
*A history of documented prior upper [[Gastrointestinal tract|GI]] [[bleeding]] is important because approximately 60% of upper [[Gastrointestinal tract|GI]] bleeders are rebleeding from the same site. | |||
*A history of [[pancreatitis]] suggests possible [[hemorrhage]] from a [[pancreatic pseudocyst]]. Erosion of a [[pancreatic pseudocyst]] into the [[duodenum]] or [[stomach]] may cause massive [[hematemesis]], and the patient may present in [[shock]].<ref name="pmid16955152">{{cite journal |vauthors=Stermer E, Elias N, Keren D, Rainis T, Goldstein O, Lavy A |title=Acute pancreatitis and upper gastrointestinal bleeding as presenting symptoms of duodenal Brunner's gland hamartoma |journal=Can. J. Gastroenterol. |volume=20 |issue=8 |pages=541–2 |year=2006 |pmid=16955152 |pmc=2659938 |doi= |url=}}</ref><ref name="pmid26591952">{{cite journal |vauthors=Rana SS, Sharma V, Bhasin DK, Sharma R, Gupta R, Chhabra P, Kang M |title=Gastrointestinal bleeding in acute pancreatitis: etiology, clinical features, risk factors and outcome |journal=Trop Gastroenterol |volume=36 |issue=1 |pages=31–5 |year=2015 |pmid=26591952 |doi= |url=}}</ref><ref name="pmid18376304">{{cite journal |vauthors=Sharma PK, Madan K, Garg PK |title=Hemorrhage in acute pancreatitis: should gastrointestinal bleeding be considered an organ failure? |journal=Pancreas |volume=36 |issue=2 |pages=141–5 |year=2008 |pmid=18376304 |doi=10.1097/MPA.0b013e318158466e |url=}}</ref> | |||
*Patients with [[renal failure]] frequently have [[Gastrointestinal tract|GI]] [[bleeding]]. This bleeding is often due to [[peptic ulcer disease]] or [[angiodysplasia]]. This [[bleeding]] may be severe because of [[clotting]] [[dysfunction]] associated with [[renal disease]].<ref name="pmid8931412">{{cite journal |vauthors=Chalasani N, Cotsonis G, Wilcox CM |title=Upper gastrointestinal bleeding in patients with chronic renal failure: role of vascular ectasia |journal=Am. J. Gastroenterol. |volume=91 |issue=11 |pages=2329–32 |year=1996 |pmid=8931412 |doi= |url=}}</ref><ref name="pmid3872616">{{cite journal |vauthors=Zuckerman GR, Cornette GL, Clouse RE, Harter HR |title=Upper gastrointestinal bleeding in patients with chronic renal failure |journal=Ann. Intern. Med. |volume=102 |issue=5 |pages=588–92 |year=1985 |pmid=3872616 |doi= |url=}}</ref> | |||
===Medication History=== | |||
*Prior use of [[aspirin]] or [[Non-steroidal anti-inflammatory drug|nonsteroidal anti-inflammatory drugs]] (NSAIDs) is important because these patients have an increased risk of [[gastric ulcer]] and a fourfold risk of significant [[Gastrointestinal tract|GI]] [[bleeding]] compared with other patients.<ref name="pmid5303551">{{cite journal |vauthors=Goulston K, Cooke AR |title=Alcohol, aspirin, and gastrointestinal bleeding |journal=Br Med J |volume=4 |issue=5632 |pages=664–5 |year=1968 |pmid=5303551 |pmc=1912769 |doi= |url=}}</ref> | |||
===Social History=== | |||
*A history of [[alcoholism]] increases the likelihood of [[cirrhosis]] and consequently of [[bleeding]] from [[esophageal varices]] or congestive gastropathy but alcoholics also frequently have [[peptic ulcers]] or [[gastritis]].<ref name="pmid2226291">{{cite journal |vauthors=MacMath TL |title=Alcohol and gastrointestinal bleeding |journal=Emerg. Med. Clin. North Am. |volume=8 |issue=4 |pages=859–72 |year=1990 |pmid=2226291 |doi= |url=}}</ref><ref name="pmid5303551">{{cite journal |vauthors=Goulston K, Cooke AR |title=Alcohol, aspirin, and gastrointestinal bleeding |journal=Br Med J |volume=4 |issue=5632 |pages=664–5 |year=1968 |pmid=5303551 |pmc=1912769 |doi= |url=}}</ref> | |||
*[[Cigarette smoke|Cigarette smokers]] have a significantly higher rate of the recurrent [[duodenal ulcer]] as compared with nonsmokers and a history of [[cigarette smoking]] should be elicited. | |||
*[[Vomiting]], [[coughing]], or [[retching]] before [[bleeding]] is suggestive of a [[Mallory-Weiss tear]].<ref name="pmid28839832">{{cite journal |vauthors=Jafar W, Jafar AJN, Sharma A |title=Upper gastrointestinal haemorrhage: an update |journal=Frontline Gastroenterol |volume=7 |issue=1 |pages=32–40 |year=2016 |pmid=28839832 |pmc=5369541 |doi=10.1136/flgastro-2014-100492 |url=}}</ref><ref name="pmid17942452">{{cite journal |vauthors=Palmer K |title=Acute upper gastrointestinal haemorrhage |journal=Br. Med. Bull. |volume=83 |issue= |pages=307–24 |year=2007 |pmid=17942452 |doi=10.1093/bmb/ldm023 |url=}}</ref> | |||
===Past Surgical History=== | |||
*Patients with prior [[abdominal aortic aneurysm]] repair may present with severe GI [[hemorrhage]] from an aortoenteric. This [[fistula]] often presents with a herald bleed followed within 4 to 96 hours by [[massive bleeding]].<ref name="pmid25136194">{{cite journal |vauthors=Adarsh CK, Kiran R, Mallikarjun |title=An unusual cause of gastrointestinal bleed |journal=Indian J Crit Care Med |volume=18 |issue=8 |pages=533–5 |year=2014 |pmid=25136194 |pmc=4134629 |doi=10.4103/0972-5229.138160 |url=}}</ref> | |||
===Family History=== | |||
*A personal or [[family history]] of recurrent [[epistaxis]] may suggest the [[diagnosis]] of [[Osler-Weber-Rendu syndrome]] ([[hereditary hemorrhagic telangiectasia]]), and a careful examination for skin [[telangiectasias]] should be performed. <ref name="pmid28070235">{{cite journal |vauthors=Ou G, Galorport C, Enns R |title=Bevacizumab and gastrointestinal bleeding in hereditary hemorrhagic telangiectasia |journal=World J Gastrointest Surg |volume=8 |issue=12 |pages=792–795 |year=2016 |pmid=28070235 |pmc=5183923 |doi=10.4240/wjgs.v8.i12.792 |url=}}</ref> | |||
==References== | ==References== | ||
Revision as of 16:27, 20 November 2017
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2]
Obtaining the history is the most important aspect of making a diagnosis of upper GIbleed. It provides insight into the cause, precipitating factors and associated comorbid conditions and also helps in determining the severity of the bleed as well as in identifying the potential source of bleed. Patients may be disoriented, therefore, the patient interview may be difficult. In such cases, history from the care givers or the family members may need to be obtained. [1][2]Past Medical History
- A history of epigastric pain, dyspepsia, or prior peptic ulcer may suggest the diagnosis of peptic ulcer disease.[3]
- A history of documented prior upper GI bleeding is important because approximately 60% of upper GI bleeders are rebleeding from the same site.
- A history of pancreatitis suggests possible hemorrhage from a pancreatic pseudocyst. Erosion of a pancreatic pseudocyst into the duodenum or stomach may cause massive hematemesis, and the patient may present in shock.[4][5][6]
- Patients with renal failure frequently have GI bleeding. This bleeding is often due to peptic ulcer disease or angiodysplasia. This bleeding may be severe because of clotting dysfunction associated with renal disease.[7][8]
Medication History
- Prior use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) is important because these patients have an increased risk of gastric ulcer and a fourfold risk of significant GI bleeding compared with other patients.[9]
Social History
- A history of alcoholism increases the likelihood of cirrhosis and consequently of bleeding from esophageal varices or congestive gastropathy but alcoholics also frequently have peptic ulcers or gastritis.[10][9]
- Cigarette smokers have a significantly higher rate of the recurrent duodenal ulcer as compared with nonsmokers and a history of cigarette smoking should be elicited.
- Vomiting, coughing, or retching before bleeding is suggestive of a Mallory-Weiss tear.[11][12]
Past Surgical History
- Patients with prior abdominal aortic aneurysm repair may present with severe GI hemorrhage from an aortoenteric. This fistula often presents with a herald bleed followed within 4 to 96 hours by massive bleeding.[13]
Family History
- A personal or family history of recurrent epistaxis may suggest the diagnosis of Osler-Weber-Rendu syndrome (hereditary hemorrhagic telangiectasia), and a careful examination for skin telangiectasias should be performed. [14]
References
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- ↑ Kim BS, Li BT, Engel A, Samra JS, Clarke S, Norton ID, Li AE (2014). "Diagnosis of gastrointestinal bleeding: A practical guide for clinicians". World J Gastrointest Pathophysiol. 5 (4): 467–78. doi:10.4291/wjgp.v5.i4.467. PMC 4231512. PMID 25400991.
- ↑ Bull-Henry K, Al-Kawas FH (2013). "Evaluation of occult gastrointestinal bleeding". Am Fam Physician. 87 (6): 430–6. PMID 23547576.
- ↑ Laine, Loren; Solomon, Caren G. (2016). "Upper Gastrointestinal Bleeding Due to a Peptic Ulcer". New England Journal of Medicine. 374 (24): 2367–2376. doi:10.1056/NEJMcp1514257. ISSN 0028-4793.
- ↑ Stermer E, Elias N, Keren D, Rainis T, Goldstein O, Lavy A (2006). "Acute pancreatitis and upper gastrointestinal bleeding as presenting symptoms of duodenal Brunner's gland hamartoma". Can. J. Gastroenterol. 20 (8): 541–2. PMC 2659938. PMID 16955152.
- ↑ Rana SS, Sharma V, Bhasin DK, Sharma R, Gupta R, Chhabra P, Kang M (2015). "Gastrointestinal bleeding in acute pancreatitis: etiology, clinical features, risk factors and outcome". Trop Gastroenterol. 36 (1): 31–5. PMID 26591952.
- ↑ Sharma PK, Madan K, Garg PK (2008). "Hemorrhage in acute pancreatitis: should gastrointestinal bleeding be considered an organ failure?". Pancreas. 36 (2): 141–5. doi:10.1097/MPA.0b013e318158466e. PMID 18376304.
- ↑ Chalasani N, Cotsonis G, Wilcox CM (1996). "Upper gastrointestinal bleeding in patients with chronic renal failure: role of vascular ectasia". Am. J. Gastroenterol. 91 (11): 2329–32. PMID 8931412.
- ↑ Zuckerman GR, Cornette GL, Clouse RE, Harter HR (1985). "Upper gastrointestinal bleeding in patients with chronic renal failure". Ann. Intern. Med. 102 (5): 588–92. PMID 3872616.
- ↑ 9.0 9.1 Goulston K, Cooke AR (1968). "Alcohol, aspirin, and gastrointestinal bleeding". Br Med J. 4 (5632): 664–5. PMC 1912769. PMID 5303551.
- ↑ MacMath TL (1990). "Alcohol and gastrointestinal bleeding". Emerg. Med. Clin. North Am. 8 (4): 859–72. PMID 2226291.
- ↑ Jafar W, Jafar A, Sharma A (2016). "Upper gastrointestinal haemorrhage: an update". Frontline Gastroenterol. 7 (1): 32–40. doi:10.1136/flgastro-2014-100492. PMC 5369541. PMID 28839832. Vancouver style error: initials (help)
- ↑ Palmer K (2007). "Acute upper gastrointestinal haemorrhage". Br. Med. Bull. 83: 307–24. doi:10.1093/bmb/ldm023. PMID 17942452.
- ↑ Adarsh CK, Kiran R, Mallikarjun (2014). "An unusual cause of gastrointestinal bleed". Indian J Crit Care Med. 18 (8): 533–5. doi:10.4103/0972-5229.138160. PMC 4134629. PMID 25136194.
- ↑ Ou G, Galorport C, Enns R (2016). "Bevacizumab and gastrointestinal bleeding in hereditary hemorrhagic telangiectasia". World J Gastrointest Surg. 8 (12): 792–795. doi:10.4240/wjgs.v8.i12.792. PMC 5183923. PMID 28070235.