HPI
- Appearance ( bright red – from esophagus; “coffee grounds” – from lower GI)
- When? Frequency?
- How much?
- What else is happening? – vomiting, illness, etc
- Pain (ulcer – epigastric)
- Signs of liver disease (EtOH, hepatitis, jaundice, bruising, ascites, etc)
- EtOH (gastritis)
- Epistaxis, hemoptysis, oropharynx
- GERD (esophagitis)
- Melena (long duration >12 hours)
- Anemia – how severe (orthostatic hTN, fatigue, pale, SOB, CP, tachycardia, diaphoresis)
- Family History
Past medical history
- PUD
- Risks: NSAIDS, FHx, personal Hx, smoking
- Prior episodes
- Alcohol abuse and smoking
- Hepatic, renal, cardiac, pulmonary or bleeding disorders
- Systemic illness or major surgery
Medications
- Predisposing medications (ASA, NSAIDS, anticoagulants
Differential Diagnosis
- Mallory Weiss tear
- Varices
- PUD
- Gastritis
- Esophagitis
- Cancer
- Trauma
- Dieulafoy lesion
- Aorto-duodenal fistula
- Boerhave’s syndrome (esophageal rupture)