Snap Shot
  • A 65-year-old man with a history of alcoholism, tobacco, and hypertension presents to the general surgery clinic, where he was referred for a further evaluation of blood in his stool. He reports occasional abdominal pain that is relieved transiently with meals. One episode of vomiting occurred with the pain. Recently, stools have been black. Examination reveals spider angiomas, but no palmar erythema or hepatosplenomegaly. The following angiogram was performed.
  • Causes include
    • PUD
    • gastritis
    • esophageal varices
    • Mallory-Weis tear
    • gastric cancer
    • vascular abnormalities
    • esophagitis
  • Risk factors include
    • EtOH
    • tobacco
    • liver disease
    • NSAID use
    • vomiting
  • Symptoms
    • hematemesis (coffee ground)
    • hematochezia
    • hypotension
  • Physical exam
    • abdominal pain
    • anorexia
    • bloody emesis
    • dark stools
    • blood per rectum
  • Labs
    • may have normal hematocrit
      • not accurate measure of blood loss
  • NG tube / lavage
  • Endoscopy
  • Medical
    • IV fluid resuscitation and transfusions for hemodynamic stability
  • Surgical
    • endoscopy with banding or sclerotherapy
    • surgical exploration may be required if uncontrollable bleeding, though difficult if cervical or upper thoracic GI tract

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