...
Is it true or false melena? False melena may be induced by iron ingestion, bismuth ingestion, charcoal ingestion, red wine ingestion, and many other substances.
Is there a history of ... DIAGNOSTIC WORKUP
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What is the WBC count? Thrombocytopenia with a high white count suggests leukemia or myeloid metaplasia. Thrombocytopenia with a normal white count suggests idiopathic thrombocytopenic ... DIAGNOSTIC WORKUP
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Is there a petechial rash? The presence of a petechial rash suggests either a thrombocytopenic purpura, which may be idiopathic or secondary to leukemia, aplastic ... DIAGNOSTIC WORKUP
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Are there abnormalities on examination of the teeth or gums? The gums may be swollen, as in phenytoin use and early scurvy, and bleed on slight pressure, as in pyorrhea ... DIAGNOSTIC WORKUP
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Is it severe? The presence of severe rectal bleeding would suggest ulcerative colitis, amebic dysentery, bacillary dysentery, intussusception, mesenteric thrombosis or ... DIAGNOSTIC WORKUP
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Because the differential diagnosis of purpura is very large, begin by determining whether the purpura is palpable or nonpalpable. Subsequent workup is dictated by the history, physical, and review of systems to determine... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Everyone bleeds; however, most episodes of minor bleeding promptly cease with activation of the normal clotting cascade. Bleeding is considered abnormal when it occurs spontaneously without injury or if it does not... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Uterine bleeding is abnormal when the pattern (amount and/or duration) is irregular. Menorrhagia indicates regular but excessive uterine bleeding; metrorrhagia indicates irregular and, often, more frequent uterine bleeding; and... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Lower GI tract bleeding occurs distal to the ligament of Treitz (which separates the duodenum from the jejunum) and refers to the passage of either bright red blood per rectum ... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Hematemesis refers to vomiting of clots, fresh blood, or “coffee grounds” and generally represents bleeding from the upper GI tract (i.e., proximal to the ligament of Treitz). May be associated with black,... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Purpura represents leakage of blood from vessels into skin/mucous membranes; thus, it is nonblanching on pressure; petechiae are <3 mm, ecchymosis >3 mm in diameter. Idiopathic thrombocytopenic>... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Thrombocytopenia is defined as a platelet count of <150,000. Mild (100,000–150,000) and moderate (50,000–100,000) thrombocytopenia are rarely associated with significant bleeding. In contrast>... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Age of the patient is important when considering the differential diagnosis of abnormal vaginal bleeding. Pregnancy should always be ruled out despite a negative history of sexual activity... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Chronic diarrhea (nonbloody, without weight loss) is defined as increased total daily stool output (greater than 10 g/kg/day), associated with increased stool water content; diarrhea is classified as chronic when it lasts longer than 2 weeks.... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Hemorrhages in the retina represent a broad range of ocular manifestations of systemic disease and/or trauma. The most important diagnosis to discover is nonaccidental trauma. Recognition of the... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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... The mnemonic VINDICATE is very useful to develop a list of causes of thrombocytopenia.
THROMBOCYTOPENIA
V—
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... Conditions of the skin, subcutaneous tissue, vascular wall, and blood may all be associated with bleeding under the skin or purpura, thus both anatomy and physiology
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... Bleeding from the Ear
This is not usually a serious condition. Anatomy is again applied to formulate a diagnosis. The blood may be from the external or middle ear and usually is caused by diseases
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... This discussion considers the causes of bright red or maroon stools. (The causes of melena or black stools are the same as the causes of hematemesis; the differential diagnosis is given on page 261.) Bright-red blood may occasionally
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... As with most hemorrhages from body orifices, vaginal bleeding is best approached by the anatomic method. Thus, the important structures of the female genital tract are cross-indexed with etiologic categories as
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... Hematemesis means vomiting or regurgitation of frank bright red blood or coffee-ground material that is positive for occult blood. It may be differentiated from hemoptysis because it usually gives
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... A common sign of upper GI bleeding, melena is the passage of black, tarry stools containing digested blood. The characteristic color results from bacterial degradation and... Emergency Interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Pictures
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... Purpura is the extravasation of red blood cells from the blood vessels into the skin, subcutaneous tissue, or mucous membranes. It’s characterized by discoloration that’s easily visible through the epidermis,... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Pictures
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... Bleeding gums usually result from dental disorders; less commonly, they may stem from a blood dyscrasia or the effects of certain drugs. Physiologic causes of this common sign include pregnancy, which can produce gum swelling... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers
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... Postmenopausal vaginal bleeding — bleeding that occurs 6 or more months after menopause — is an important indicator of gynecologic cancer. But it can also result from infection, a... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Geriatric pointers
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... Low blood pressure refers to inadequate intravascular pressure to maintain the oxygen requirements of the body's tissues. Although commonly linked to shock, this sign may also... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pictures
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... Elevated blood pressure — an intermittent or sustained increase in blood pressure exceeding 140/90 mm Hg — strikes more men than women and twice as many Blacks as Whites. By itself, this common sign is easily ignored by
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... Decreased Production
Primary hematologic disorders
Aplastic anemia
Acute leukemia
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... Upper Gastrointestinal Bleeding
Inflammation
Esophageal ulcer
Gastric ulcer*
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... Platelet Disorders
Thrombocytopenia
Drugs, especially
Cytotoxic agents
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... The most common cause of hemorrhagic disorders, thrombocytopenia is characterized by deficiency of circulating platelets. Because platelets play a vital role in coagulation, this disease poses a serious threat to hemostasis. (See What... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations ... Pictures
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... Abnormal premenopausal bleeding refers to any bleeding that deviates from the normal menstrual cycle before menopause. These deviations include menstrual bleeding that’s abnormally infrequent (oligomenorrhea),... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations ... Pictures
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... Signs and Symptoms Bright red, bloody vomitus; cold, clammy skin; hypotension; tachycardia; respiratory distress; anxiety
Treatment (Tx)
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... Mediated by immune or nonimmune factors, a transfusion reaction accompanies or follows I.V. administration of blood components. Its severity varies from mild (fever and chills) to severe (acute renal failure or complete vascular... Causes ... Signs and symptoms ... Diagnosis ... Treatment
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... Dysfunctional uterine bleeding (DUB) refers to abnormal endometrial bleeding without recognizable organic lesions. The prognosis varies with the cause. DUB is the indication for almost 25%... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... Signs and Symptoms Bright red blood from rectum or mouth, hypotension, tachycardia, nausea, decreased urine output, decreased level of consciousness, increased respiratory rate, cold,... Treatment (Tx)
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... Hereditary hemorrhagic telangiectasia (also called Osler-Weber-Rendu syndrome) is an inherited vascular disorder in which venules and capillaries dilate to form fragile masses of thin convoluted vessels ... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... Postmenopausal bleeding is defined as bleeding from the reproductive tract that occurs 1 year or more after cessation of menses. Sites of bleeding include the vulva, vagina, cervix, and... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... Allergic purpura, a nonthrombocytopenic purpura, is an acute or chronic vascular inflammation affecting the skin, joints, and GI and genitourinary (GU) tracts, in association with allergy... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations ... Pictures
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... Idiopathic thrombocytopenic purpura (ITP), thrombocytopenia that results from immunologic platelet destruction, may be acute (postviral thrombocytopenia) or chronic (Werlhof’s disease, purpura hemorrhagica, essential... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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Melena
(Professional Guide to Signs & Symptoms (Fifth Edition))
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... A common sign of upper GI bleeding, melena is the passage of black, tarry stools containing digested blood. Characteristic color results from bacterial degradation and hydrochloric acid acting on the... Emergency Interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Pictures
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Purpura
(Professional Guide to Signs & Symptoms (Fifth Edition))
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... Purpura is the extravasation of red blood cells from the blood vessels into the skin, subcutaneous tissue, or mucous membranes. It’s characterized by discoloration that’s easily visible through the epidermis, usually purplish or... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Pictures
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... Bleeding gums usually result from dental disorders; less often, they may stem from blood dyscrasias or the effects of certain drugs. Physiologic causes of this common sign include pregnancy, which can produce gum swelling... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... Postmenopausal vaginal bleeding—bleeding that occurs 6 or more months after menopause—is an important indicator of gynecologic cancer. But it can also result from infection, a local pelvic disorder,... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Geriatric pointers ... Patient counseling
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... Low blood pressure refers to inadequate intravascular pressure to maintain the the body’s oxygen requirements. Although commonly linked to shock, this sign may also result from cardiovascular, respiratory, neurologic, or metabolic... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... Elevated blood pressure—an intermittent or sustained increase in blood pressure exceeding 140/90 mm Hg—strikes more men than women and twice as many Blacks as Whites... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... The passage of bloody stools, also known as hematochezia, usually indicates—and may be the first sign of—GI bleeding below the ligament of Treitz. However, this sign—usually preceded by... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers
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Thrombocytopenia
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
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... Mark D. Darrow
A low platelet count is usually brought to the attention of the practitioner as the result of an automated complete blood count in an asymptomatic patient (1). ... Pictures
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... Mark B. Stephens
Gastrointestinal (GI) bleeding is responsible for 1% to 2% of all hospital admissions in the United States (1). Bleeding can be either acute or chronic. The source can be upper or lower, overt or... Approach ... History ... Physical examination ... Laboratory evaluation ... Diagnostic assessment ... Pictures
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Postmenopausal Bleeding
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
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... Victoria S. Kaprielian
Postmenopausal bleeding is defined as vaginal bleeding that occurs in a woman who has had no menses for a year or more. This is a common outpatient... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment
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Rectal Bleeding
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
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... Ted Epperly
Rectal bleeding is a common problem encountered by primary care providers across the United States. Annually, approximately 3% of the... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment ... Pictures
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Petechiae and Purpura
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
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... John L. Smith
Purpura are the visible extravasation of blood into the skin or mucous membranes. Petechiae are purpura less than 2 mm in diameter and ecchymoses are greater... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment (4)
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... Differential Overview
Purpura
❑Trauma
❑Senile purpura
❑Drugs ... Diagnostic Approach ... Clinical Findings ... Pictures
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... Differential Overview
Upper GI
❑ Peptic ulcer disease
❑ Gastritis
❑... DIagnostic Approach ... Clinical Findings ... Pictures
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... Differential Overview
❑ Ovulatory bleeding
❑ Anovulatory bleeding
❑ Uterine leiomyoma ... Diagnostic Approach ... Clinical Findings
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... The most common cause of hemorrhagic disorders, thrombocytopenia is characterized by deficiency of circulating platelets. Because platelets play a vital role in coagulation, this... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations ... Pictures
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... Allergic purpura, or anaphylactoid purpura, is a type of nonthrombocytopenic purpura. It’s characterized by allergy symptoms and acute or chronic vascular inflammation affecting the... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... Idiopathic thrombocytopenic purpura (ITP), thrombocytopenia that results from immunologic platelet destruction, may be acute (postviral thrombocytopenia) or chronic (Werlhof’s disease, purpura... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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Melena
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
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... A common sign of upper GI bleeding, melena is the passage of black, tarry stools containing digested blood. Characteristic color results from bacterial degradation and hydrochloric... Assessment ... History ... Physical examination ... Pediatric pointers ... Geriatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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... Low blood pressure or hypotension refers to inadequate intravascular pressure to maintain the oxygen requirements of the body’s tissues. Although commonly linked to shock, this sign may also result from a... Assessment ... History ... Physical examination ... Pediatric pointers ... Geriatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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... Elevated blood pressure (hypertension) is defined as an intermittent or sustained increase in blood pressure exceeding 140/90 mm Hg. Hypertension strikes more men than women and twice as many blacks as whites. Its causes can be life... Assessment ... History ... Physical examination ... Pediatric pointers ... Geriatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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Melena
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
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... A common sign of upper GI bleeding, melena is the passage of black, tarry stools containing digested blood. Characteristic color results from bacterial degradation and hydrochloric... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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Purpura
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
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... Purpura is the extravasation of red blood cells from the blood vessels into the skin, subcutaneous tissue, or mucous membranes. It’s characterized by discoloration that’s easily visible through the epidermis, usually... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... Postmenopausal vaginal bleeding — bleeding that occurs 6 or more months after menopause — is an important indicator of gynecologic cancer, but it can also result from infection, a local pelvic disorder,... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Geriatric pointers ... Patient counseling ... Pictures
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... Bleeding gums, or gingival bleeding, usually result from dental disorders; less commonly, they may stem from a blood dyscrasia or the effects of certain drugs. Physiologic causes of this common sign include pregnancy, which can produce gum... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... Low blood pressure, also known as hypotension, refers to inadequate intravascular pressure to maintain the oxygen requirements of the body’s tissues. Typically, a... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... Elevated blood pressure — an intermittent or sustained increase in blood pressure exceeding 140/90 mm Hg — strikes more men than women. By itself, this common sign is easily ignored by the patient; after all, he can’t see... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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...Purpura are macular discolorations that donot blanch or disappear with pressure. They include petechiae (<3mm in diameter) and ecchymoses (larger lesions). Principal Causes of Purpura and Bleeding > ... Clinical Features and Diagnosis ... Diagnostic Approach ... References
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... Can occuranywhere from nose and mouth to anus. Bleeding that occurs proximal to ligamentof Treitz is considered upper tract bleeding, whereas bleeding thatoccurs distal to this ligament is considered lower... Principal Causes of Gastrointestinal Bleeding ... Clinical Features and Diagnosis ... Diagnostic Approach ... References
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... Vaginalbleeding is physiologic in the neonatal period and during the normalmenstrual cycle. Maternal estrogen stimulates endometrial growthin the fetus, but after delivery, the... Principal Causes of Vaginal Bleeding ... Clinical Features and Diagnosis ... Diagnostic Approach ... References
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... A common sign of upper GI bleeding, melena is the passage of black, tarry stools containing digested blood. The characteristic color results from bacterial degradation and hydrochloric acid acting on the... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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... Purpura is the extravasation of red blood cells from the blood vessels into the skin, subcutaneous tissue, or mucous membranes. It's characterized by discoloration that's easily... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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... Bleeding gums usually result from dental disorders; less commonly, they may stem from a blood dyscrasia or the effects of certain drugs. Physiologic causes of this common sign... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
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... Postmenopausal vaginal bleeding—bleeding that occurs 6 or more months after menopause—is an important, albeit not a definitive, indicator of gynecologic cancer. It can also... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
... READ MEDICAL BOOK EXCERPTS ONLINE » (free access, no registration)
... Low blood pressure refers to inadequate intravascular pressure to maintain the oxygen requirements of the body's tissues. Although commonly linked to shock, this sign may also result from a cardiovascular, respiratory,... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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... Elevated blood pressure or hypertension (an intermittent or sustained increase in blood pressure of 140/90 mm Hg) strikes more men than women and twice as many Blacks as Whites. By itself, this common sign is... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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... The passage of bloody stools, also known as hematochezia, usually indicates—and may be the first sign of—GI bleeding below the ligament of Treitz. However, this sign—usually preceded by... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
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...
The mnemonic VINDICATE is very useful to develop a list of
causes of thrombocytopenia.
V—Vascular disorders should help
the recall of... Pictures
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...
Conditions of the skin, subcutaneous tissue, vascular wall, and blood
may all be associated with bleeding under the skin or purpura, thus both
anatomy and physiology must be used to develop this... Pictures
... READ MEDICAL BOOK EXCERPTS ONLINE » (free access, no registration)
...
Bleeding from the ear. This is not usually a serious
condition. Anatomy is again applied to formulate a diagnosis. The
blood may be from the external or middle ear, and
... READ MEDICAL BOOK EXCERPTS ONLINE » (free access, no registration)
...
This discussion considers the causes of bright red or maroon stools.
(The causes of melena or black stools are the same as the causes of
hematemesis; the differential diagnosis is given on... Pictures
... READ MEDICAL BOOK EXCERPTS ONLINE » (free access, no registration)
...
As with most hemorrhages from body orifices, vaginal bleeding is best
approached by the anatomic method. Thus, the important structures
of the female genital tract are... Pictures
... READ MEDICAL BOOK EXCERPTS ONLINE » (free access, no registration)
...
Hematemesis means vomiting or regurgitation of frank bright red
blood or coffee-ground material that is positive for occult blood. It may be
differentiated from hemoptysis... Pictures
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... Author:
Dorothy Chen, MD
What to Do - Gather Appropriate Data
Patients can present with bleeding after trauma, during or after a procedure,
or secondary to a... Suggested Readings
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... Char Witmer, MDLeslie Raffini, MD (4th Edition) Abnormal Bleeding - BASICS Abnormal Bleeding - description Abnormal bleeding may present as: ... Abnormal Bleeding - DIAGNOSIS ... Abnormal Bleeding - TREATMENT ... Abnormal Bleeding - FOLLOW UP ... Abnormal Bleeding - bibliography ... Abnormal Bleeding - CODES ... Abnormal Bleeding - FAQ
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