Emergency Cases Northwest Group

037 Bloody Confusion

Situation

Upper GI bleed (UGIB) caused frank blood per rectum.

Background

A 67 year old alcoholic patient presented with frank haematemesis and meleana, likely oesophageal varices. He also had frank red blood PR, which was seen on examination too. He was treated with terlipressin, abx, FFP, vit K and referred for urgent endoscopy.

Assessment

His UGIB was brisk, causing the new blood to transit quickly from the stomach to the rectum unchanged. When blood in the GI tract has time to digest and then passed PR it changes to black meleana [in his case he had meleana and frank blood PR].

Recommendation

PR bleeding might not be just from a lower GI cause such as colitis, diverticulitis or cancer.

If the patient has risk factors or has had an UGIB before, consider that as a possibility too.

In this case his history, haematemesis and meleana made it obvious it was a UGIB.

But a patient with UGIB might present just with PR bleeding only.



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Emergency Cases Northwest Group