1. Explain the significance of the following in the protocol that my have a bearing to this patient's chief complaint. Answer
History
Black stools.
Lightheadedness.
Sticky malodorous stools.
NSAID's.
Physical
Postural hypotension.
No telengiectasia.
No spider nevi.
Full Parotid glands.
Lab
Type of anemia.
BUN and Creatinine.
2. What is the major clinical problem (not the diagnosis)? Answer
3. What is most likely cause for the black stools based on the information you have gathered so far? Answer
4. What physical findings and lab data support a diagnosis of acute bleeding? Answer
5. What is the likely location of bleeding site in GI tract Answer
6.What makes the stool blood black? Answer
7. What amount of blood loss is required to produce each of the following: Answer
8. Now that you have localized the probable area for a bleeding source develop a differential diagnosis for the problem. Answer
9. Discuss the likely diagnosis. Cite data to support your diagnosis. Describe the clinical scenario for other diagnosis that you have listed as possibilities. Answer
10. Now that you have the differential, what are the historical information that you will gather in evaluation of acute upper GI bleed? Answer
11. What physical findings will you be looking for? Answer
12. Prioritize steps that would likely be taken in the ER to treat this patient. Answer
13. A nasogastric tube was placed by the ER resident. The aspirate reveals a clear return. What does this mean? Does this change or alter your diagnosis? Answer
14. Interpret the possible returns from nasogastric tube Answer
15. What will be the ideal procedure to confirm the location of bleeding site and why? Answer
16. 70/plus% of UGI bleeds will cease spontaneously. What is the advantage of doing EGD in every case? Answer
17. List factors that increase the mortality and morbidity from UGI bleeding. Answer
18. What are the endoscopic findings suggesting increased risk for rebleeding? Answer