Melena

MELENA 1. CHIEF COMPLAINT •Melena 2. HPI 1. Concern 2. Onset Sudden Gradual 3. Duration •Recent •A few days •Many days •A few weeks •Many weeks •A few months •Many months •A few years •Many years •Recurrent •n/a 4. Severity •Mild •Moderate •Severe •Normal •Increased •Decreased •Stable •No significant change from prior visit 5. Frequancy 6. Aggravated by •Hard stools •Using NSAIDs 7. 8.

Relieved by Associated Symptoms a. Abdominal pains b. Vomiting blood c. Bloating

d. Excessive gas e. Diarrhea f. Fever 9. Pertinent Negatives 10. Notes 3. ROS 4. ASSOCIATED SYMPTOMS •Abdominal pains •Vomiting blood •Bloating •Excessive gas •Diarrhea •Fever 5. HISTORY a. FAMILY HISTORY •Diabetes •Hypertension a. SOCIAL HISTORY •Smoking •Alcohol b. PASTMEDICAL HISTORY •Duodenal ulcer •Gastritis •Esophageal varices •Mallory-Weiss tear •Bowel ischemia •Vascular malformation •Hemorrhoids •Anal fissures •Diverticular bleeding •Bacterial enterocolitis) a. SURGICAL HISTORY b. CHRONIC CONDITIONS •Inflammatory bowel disease •Colon polyps

•Colon cancer 6. ALLERGIES 7. PHYSICAL EXAMINATION 8. SPECIFIC DATA LIKE GRADING ETC 9. DIFFERENTIAL DIAGNOSIS •Duodenal ulcer •Gastritis •Esophageal varices •Mallory-Weiss tear •Bowel ischemia •Vascular malformation •Hemorrhoids •Anal fissures •Diverticular bleeding •Bacterial enterocolitis) •Inflammatory bowel disease •Tumor •Colon polyps •Colon cancer 10.TESTS TO BE ORDERED •Blood studies, including a CBC and blood differential •Colonoscopy •Gastroscopy or EGD •Bleeding scan •Angiography •Barium studies •Stool culture •X-rays of the abdomen •USG •CT scan •MRI •Tests for the presence of Helicobacter pylori infection 11.ASSESSMENT /PLAN •Stop using the NSAIDs •Bowel resection for bowel ischemia •Hemorrhoidectomy for hemorrhoids

12.EDUCATION •Eat vegetables and foods rich in natural fiber and low in saturated fat. •Avoid prolonged, excessive use of anti-inflammatory drugs like ibuprofen, naproxen, and aspirin. •If you drink alcohol, do so in moderation. •DON'T smoke. •Try to avoid too much stress 13.MEDICATION •Ranitidine •Omeprazole •Rabeprazole 14.FOLLOW-UP