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    1) The patient presented with confusion after femoral hernia repair and taking diclofenac. Examination found upper abdominal tenderness. 2) The diagnoses was melena, likely caused by upper GI bleeding from the stress of surgery and diclofenac use. Melena refers to dark stools caused by stomach acids acting on blood. 3) Recommended acute management of GI bleeding includes protecting the airway, intravenous fluids and blood transfusions, urinary catheter, monitoring, transfer to high dependency unit, urgent endoscopy within 24 hours if stable or immediately if unstable, and starting a PPI. Surgical or radiological intervention may be needed if bleeding is not controlled endoscopically.

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    1) The patient presented with confusion after femoral hernia repair and taking diclofenac. Examination found upper abdominal tenderness. 2) The diagnoses was melena, likely caused by upper GI bleeding from the stress of surgery and diclofenac use. Melena refers to dark stools caused by stomach acids acting on blood. 3) Recommended acute management of GI bleeding includes protecting the airway, intravenous fluids and blood transfusions, urinary catheter, monitoring, transfer to high dependency unit, urgent endoscopy within 24 hours if stable or immediately if unstable, and starting a PPI. Surgical or radiological intervention may be needed if bleeding is not controlled endoscopically.

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    5 views45 pages

    One Paper 1

    Uploaded by

    hamada01062942711
    1) The patient presented with confusion after femoral hernia repair and taking diclofenac. Examination found upper abdominal tenderness. 2) The diagnoses was melena, likely caused by upper GI bleeding from the stress of surgery and diclofenac use. Melena refers to dark stools caused by stomach acids acting on blood. 3) Recommended acute management of GI bleeding includes protecting the airway, intravenous fluids and blood transfusions, urinary catheter, monitoring, transfer to high dependency unit, urgent endoscopy within 24 hours if stable or immediately if unstable, and starting a PPI. Surgical or radiological intervention may be needed if bleeding is not controlled endoscopically.

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    of 45

    ) 92 ) 5- Acute management of a

    gastrointestinal bleed:
    Kay: Cofused after femoral hernia
    repair ..taking diclofene ... upper 1) Protect airway and administer high -
    abdominal tenderness flow oxygen.
    Case of melena 2) Insert two large - bore (14--16 g)
    1- causes of postoperative confusion cannulae and take blood for full blood
    count, renal function, liver function,
     infection clotting and crossmatch 4-6 units.
     MI
    3) Replace fluid, until blood is
     pulmolary enbolism
    available.
     opiate medication
     Alcohol withdrawal 4) Insert a urinary catheter and a
     acute blood loss central venous line with strict fluid
    balance monitoring
    2- diagnoses :
    5) Transfer to an appropriate level of
    Melena Based on the stress from care, i.e. a high - dependency unit.
    surgery +NSAIDs "diclofene" causing
    upper git bleeding Melena mean 6) Arrange an urgent endoscopy: less
    abnormal dark terry faeces caused by than 24h if stable, immediate if
    action of stomach on blood unstable despite appropriate
    resuscitation.
    3- causes
    7) If you suspect variceal bleeding
     Mallory weiss tear (signs chronic liver disease or previous
     Esophageal varices variceal bleed), then perform
     Gastritis/gastric erosion endoscopy within 4 h.
     Duodenal/peptic ulcer
     Duodenitis 8 ) Start high - dose intravenous proton
     Git malignancy pump inhibitor.
     Medication "non steroidal.steroid 9) Surgical or radiological intervention
    " will be required if endoscopic therapy
    4- further clinical examination :Rectal fails to control the bleeding.
    examination : presence of melena on
    glove indicate for upper git bleeding
    ( 114 ) - CXR to exclude other pathology
    If clinical suspicion is high give
    Key :
    - anticoagulant with low
    Acutely short of breath after fractured molecularweight heparin until
    femer diagnosis is confirmed.
    - After diagnosis starte long term
    1- Diagnosis
    warfarin
    Pulmonary embolism based on c/p
    sudden shortness of breath ..pleuritic 4- investigation
     CT pulmonary angiogram.
    chest pain . History ..lower limb
     Ventelation perfusion V/Q
    surgery Laboratory .. drop PO2 ..ECG scan .
    S1Q3T3 abnormality  Duplex scan on lower limb to
    detect DVT
    2- risk factors  CXR
    - Surgery and trauma
    - Hypercoagulable states
    - Pregnancy
    - Oral contraceptives and estrogen
    replacement
    - Malignancy
    - Stroke
    - Indwelling venous catheters
    - Congestive heart failure
    - Previous history / family history of
    venous thromboembolism
    -Obesity
    3- treatment
    - Hospitalization. High flow O2
    with monitoring ABG

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