Hematemesis (OSCE)

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Contents 1 DDx 2 ABCs 3 Patient ID, CC 3.1 Vomiting 3.2 Vomitus 4 Accompanying symptoms 5 Medications 6 PMHx 7 Impression 8 Other OSCE modules

[edit] DDx

• peptic ulcer disease
• gastritis/gastropathy (NSAID, alcohol, stress related)
• Mallory-Weiss tear
• variceal rupture
• erosive esophagitis
• foreign object
• vascular malformations (Dieulafoy’s lesion, AVMs, aorto-enteric fistula)
• neoplastic disease (esophageal or gastric)
• other
  • systemic bleeding disorder
  • epistaxis
  • hemoptysis

[edit] ABCs

• hematemesis can be life threatening

[edit] Patient ID, CC

[edit] Vomiting

• onset
• precipitant (coughing, forceful vomiting)
• frequency
• characteristics (dry retching and strenuous, protracted)

[edit] Vomitus

• volume
• color (bright red, dark red, black)
• properties (coffee grounds - specks of congealed blood, pure blood, mixed with stomach contents)

[edit] Accompanying symptoms

• non GI source → epistaxis, hemoptysis, bleeding in gums/mouth, bruising, petechiae
• gastritis → GERD
• Mallory Weiss tear → strenuous or protracted vomiting
• PUD → dysphagia, odynophagia, retrosternal/epigastric discomfort
• varices → jaundice, ascites, generalized edema
• melena → bleeding > 12 hour old
• Anemia (ominous signs)
  • orthostatic lightheadedness, dyspnea, fatigue, edema
  • pallor, headache

[edit] Medications

• NSAID, ASA
• anticoagulants: warfarin, heparin, clopidegrel

[edit] PMHx

• prior episodes (diagnosis and outcome)
• PUD → smoking and EtOH
• neoplasm, malnutrition, stress ulcers → systemic illness, recent weight loss, major surgery

[edit] Impression

[edit] Other OSCE modules