GI Bleed with Case

00:00 Hello and welcome.

00:02 Today we will discuss the approach to the patient with a gastrointestinal bleed.

00:08 So, we'll begin with a case.

00:10 Mr. Gibb is a 56-year-old man with chronic knee pain who presents to the emergency department with 2 days of coffee ground emesis.

00:18 He complains of dull epigarstric pain and nausea.

00:21 He takes 800 mgs of ibuprofen 3 times a day for knee pain.

00:26 He drinks 3 to 6 beers a day.

00:29 His only medications are baby aspirin, metoprolol and ibuprofen.

00:35 His vitals show a temperature of 37, blood pressure of 89/55, heart rate: 106 and saturation of oxygen 98% on room air.

00:46 His physical exam reveals conjunctival pallor and tenderness to palpation in the epigastric region without rebound or guarding.

00:55 A nodular liver edge is palpated 5 cm below the costal margin.

01:00 His hemoglobin is 11 from a prior value of 14 and platelets are normal, his INR is 1.2.

01:09 So we are asked, what is the best next step in management? Before we answer that question, let's get to some key features in this case.

01:19 So, his symptoms of coffee ground emesis with dull epigastric pain are some of the concerning GI symptoms.

01:27 In addition, we know that he has frequent NSAID use and alcohol use.

01:33 If we look closely at his vital signs and his physical exam, we know that he has some signs that are concerning for hypovolemia, he has anemia, and some localizing symptoms on his exam that may help us with our differential.

01:48 Now let's look at his hemoglobin.

01:49 This is quite low for a normal adult, male would be from 14 to 18.

01:54 So he is anemic and we'll discuss what that means.