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Blood in stool

  • Common ddx

    • fissure, hemorrhoids, bacterial gastroenteritis, diverticulosis, C diff, gastritis, IBD, PUD
  • Serious ddx

    • intussusception, volvulus, necrotic bowel, cancer, coagulopathy
  • Admission orders

    • Admit: Floor, ICU if high risk (unstable, on anticoagulation or 3+ comorbidities)
    • Diagnosis: Lower GI bleed
    • Condition: most are stable
    • Vital Signs: q 2 hours x 2, then q 4 hours if stable.
    • Allergies:
    • Nursing:
      • Place NG tube, aspirate, and remove
      • Maintain two 16G or larger IVs at all times
      • Strict I/Os
      • DVT prophylaxis with TEDS and SCDs
    • Diet: Clear Liquids, then NPO After Midnight
    • Activity: as tolerated with fall precautions
    • Labs:
      • CBC with platelets
      • HCT q 6 hours x 4, then bid
      • Chem
      • LFTs
      • coags: PT/INR, PTT
      • FOBT to confirm bleeding
      • ECG
      • Type and cross 2 units of packed red blood cells (transfuse if Hb < 7)
      • CT if suspect diverticulitis
      • endoscopy
    • IV: NS 250 mL/h for 4 Hours, then HO Will Reassess
    • Special: GI consult, surgical consult if severe, colonoscopy
    • Medications:
      • bowel prep for colonoscopy: GoLYTELY 1 L q 30-45 minutes with a goal total of 4 L
      • d/c all NSAIDs
    • Call house officer: HR > 100 bpm, SBP < 100 mmHg
  • Discharge

    • criteria: no rebleeding in 24 hours for minor bleeds, 48-72 hours for major bleeds requiring transfusion
  • Other ddx

    • AVM, meckel's, diverticulitis, varices, ameba, rectal prolapse, iatrogenic
  • Pediatric ddx

    • NEC, intussusception, volvulus, milk protein intolerance
  • HPI

    • onset
    • triggering event
    • color of blood, quantity of blood
    • associated pain location, quality, quantity
    • alleviation, aggravation, food, antacids
    • bleeding presently
  • ROS

    • fever, nightsweats, wt loss
    • rash, erythema nodosum
    • eye pain
    • cardio, pulm: chest pain, palpitations, dyspnea
    • upper GI: esophageal pain, dysphagia, odynophagia
    • GI: abdominal pain, nausea, vomiting, diarrhea, constipation, anal pain
  • PMH

    • afib
    • coagulopathy
    • cancer
    • IBD
    • uveitis
  • FH

    • colorectal cancer
  • SH

    • EtOH
    • foreign travel
    • sick contacts
    • recent eating out
  • Meds

    • anticoagulation
    • recent antibiotics
  • Allergies

  • Px

    • vitals
    • gen impression
    • HEENT: uveitis
    • cardio: irregularity, abdominal bruits
    • pulm
    • abdominal: bowel sounds, pain, mass, rebound tenderness
    • ext: erythema nodosum
    • rectal exam: fissure, hemorrhoids

  • Print | Citations

    Disclaimer: MDHero Workups is for educational use only, and is not meant to replace the clinical judgement of a professional. We do not guarantee the accuracy of any information on this website.