Wallach's Interpretation of Diagnostic Tests: Pathways to Arriving at a Clinical Diagnosis (163 page)

   Suspect upper GI bleeding in patients presenting with hematochezia.

   Hemorrhoids and bloody diarrhea from inflammation need to be ruled out.

TABLE 5–5. Differential Diagnosis of Lower Gastrointestinal Bleeding

   Diagnostic Evaluation

   Initial assessment

   Check coagulation studies (PT, PTT, platelets, CBC, BUN, creatinine). Bleeding in uremic patients with angiodysplasia may be a result of acquired coagulopathy. May present as iron deficiency. Perform serum ferritin.

   Type and cross-match number of units appropriate for severity of blood loss.

   Endoscopic studies (assuming an upper GI bleed is excluded by virtue of nonbloody bilious fluid obtained via nasogastric lavage)

   Anoscopy may be performed to rule out bleeding hemorrhoids in appropriately selected patients.

   Colonoscopy will identify a bleeding source in approximately 80% of patients and will help control bleeding in up to 40% of patients. Other advantages include assisting in preoperative assessment.

   Neoplasms, colon: Blood in stool (occult or gross). Annual screening for occult blood detects <50% of cancers and 10% of adenomas.

Suggested Readings

Bonis PAL, Bynum TE. Angiodysplasia of the gastrointestinal tract.
www.uptodate.com
, May 2009.

Jutabha R. Etiology of lower gastrointestinal bleeding in adults.
www.uptodate.com
, May 2009.

Jutabha R. Approach to the adult patient with lower gastrointestinal bleeding.
www.uptodate.com
, May 2009.

Jutabha R, Jensen D. Approach to the adult patient with upper gastrointestinal bleeding.
www.uptodate.com
, May 2009.

Khan F, Sachs H, Pechet L, et al.
Guide to Diagnostic Testing
. Philadelphia, PA: Lippincott Williams & Wilkins; 2002.

Travis A, Saltzman J. Evaluation of occult gastrointestinal bleeding.
www.uptodate.com
, May 2009.

Villa X. Approach to upper gastrointestinal bleeding in children.
www.uptodate.com
, 1–27, May 2009.

HEPATOMEGALY

   Definition