Hematemesis (OSCE)

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DDx[edit]

  • 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

ABCs[edit]

  • hematemesis can be life threatening

Patient ID, CC[edit]

Vomiting[edit]

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

Vomitus[edit]

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

Accompanying symptoms[edit]

  • 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

Medications[edit]

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

PMHx[edit]

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

Impression[edit]

Other OSCE modules[edit]