Sandbox: manpreet kaur
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.