...
Is the constipation acute or chronic? If the constipation is acute and there is abdominal pain or vomiting, one must consider the possibility of ... DIAGNOSTIC WORKUP
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... Hemorrhoids are dilated perianal veins that become thrombosed or can rupture, producing subcutaneous or submucosal hematomas. They are usually due to chronic constipation but may be the cause of
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Is it true or false melena? False melena may be induced by iron ingestion, bismuth ingestion, charcoal ingestion, red wine ingestion, and ... 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 ... DIAGNOSTIC WORKUP
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...
Is there bleeding? The presence of bleeding with pain suggests an anal fissure, hemorrhoids, carcinoma, rectal prolapse, and intussusception.
Is there a mass? ... DIAGNOSTIC WORKUP
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Is there blood in the stool? From the algorithm, blood in the stool should indicate that there is
Salmonella
,
Shigella
,
Campylobacter jejuni
, ulcerative colitis, and ... DIAGNOSTIC WORKUP
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...
Is there a positive drug or alcohol history? It is well known that alcohol can cause diarrhea, as do drugs in common use, such as digitalis, diuretics, beta-blockers, ... DIAGNOSTIC WORKUP
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...
Constipation is a common complaint that must be accurately defined by the patient before initiating an extensive evaluation. Constipation may include fewer than three bowel movements (BMs) in a... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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...
Hemorrhoids are not protruding “varicose veins”—they are distinct from the rectal varices of portal hypertension. Rather, hemorrhoids are downwardly displaced anal cushions, which are normal... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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...
Rectal complaints are common and distressing for patients. Although most causes of rectal pain and bleeding are benign and treatable, carcinoma must be considered and ruled out in older patients (>40 years) and those with... 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)... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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...
Diarrhea is defined as an increase in the volume of bowel movements. Acute diarrhea is designated as being of less than 4 weeks’ duration. Many patients describe increased frequency or... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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...
Chronic diarrhea is defined as increased volume bowel movements persisting for more than 4 weeks. Mechanisms of diarrhea are categorized as increased secretion, decreased absorption, osmotic diarrhea, or abnormal... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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...
Constipation is a common complaint, accounting for 3% of all pediatric office visits. Stool frequency can be variable in infants, who average 4 per day (SD 1.8) at 1 week, 2.2 per day (SD 1.6)... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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...
Hematochezia refers to bright red blood per rectum (BRBPR). When the blood is maroon, the bleeding source is usually colonic. Massive upper GI bleed may rarely present with BRBPR because blood is a cathartic and children have a short... 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... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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...
Diarrhea is considered chronic when it last longer than 14 days. Weight loss with diarrhea should always be concerning and deserves thorough investigation. Collectively the malabsorption syndromes... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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...
Acute diarrhea is an abrupt onset of increased fluid content of stool above about 10 mL/kg/day and increased frequency from 4–5 to more than 20 times daily. It is a major problem... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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... The differential diagnosis of diarrhea may be approached from either an anatomic or a physiologic basis. The anatomic approach is used in Table 22. In the stomach and
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... The causes of constipation can be recalled on a physiologic basis. Normal defecation requires feces that are of proper consistency, good muscular contraction of the walls of the large intestine, and unobstructed passage of the
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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
... READ MEDICAL BOOK EXCERPTS ONLINE » (free access, no registration)
... Practically the whole specialty of proctology is devoted to taking care of patients with rectal pain. To develop the differential diagnosis it is useful first to divide the conditions into extrinsic
... 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 because it
... READ MEDICAL BOOK EXCERPTS ONLINE » (free access, no registration)
... Usually a chief sign of an intestinal disorder, diarrhea is an increase in the volume of stools compared with the patient's normal bowel habits. It varies in severity and may be acute or chronic. Acute... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pictures
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... Constipation is defined as small, infrequent, or difficult bowel movements. Because normal bowel movements can vary in frequency and from individual to individual, constipation is relative and must be determined in relation to the... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pictures
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...Rectal bleeding
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 ... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations
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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 blood as it... Emergency Interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Pictures
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... A common symptom of anorectal disorders, rectal pain is discomfort that arises in the anorectal area. Although the anal canal is separated from the rest of the rectum by the internal sphincter, the patient may refer... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers ... Geriatric pointers
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... Acute Diarrhea
Infections
Viral gastroenteritis (adenovirus, Norwalk agent, rotavirus, etc.)
Bacterial
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... Behavioral/Psychiatric Factors
Low-residue diet
Chronic laxative and/or enema abuse
Immobility
Reduced food intake
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... Upper Gastrointestinal Bleeding
Inflammation
Esophageal ulcer
Gastric ulcer*
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... Hemorrhoids are varicosities in the superior or inferior hemorrhoidal venous plexus. Dilation and enlargement of the superior plexus produce internal hemorrhoids; dilation and... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations ... Pictures
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Diarrhea
(Professional Guide to Signs & Symptoms (Fifth Edition))
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... Usually a chief sign of an intestinal disorder, diarrhea is an increase in the volume of stools compared with the patient’s normal bowel elimination habits. It varies in severity and may be acute or chronic. Acute... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... Constipation is defined as small, infrequent, or difficult bowel movements. Because normal bowel movements can vary in frequency and from individual to individual, constipation must be determined in relation to the patient... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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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 blood as it... Emergency Interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Pictures
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... A common symptom of anorectal disorders, rectal pain is discomfort that arises in the anorectal area. Although the anal canal is separated from the rest of the rectum by the internal sphincter, the patient may... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling
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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... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers
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Diarrhea
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
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... Francis G. O’Connor
Diarrhea is one of the most common clinical complaints encountered by primary care providers. Although diarrhea infrequently requires a significant diagnostic evaluation and no more... Approach ... History ... Physical examination ... Testing (5) ... Diagnostic assessment ... Pictures
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Constipation
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
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... W. Robert Kiser
Approach Constipation, defined as the passage of two or fewer stools per week (1), is the most frequently reported gastrointestinal (GI) complaint in primary... History ... Physical examination ... Diagnostic testing ... Diagnostic assessment
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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... Approach ... History ... Physical examination ... Laboratory evaluation ... Diagnostic assessment ... Pictures
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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 general population will report... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment ... Pictures
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... Differential Overview
❑ Lifestyle
❑ Drugs
❑ Depression
❑ Irritable... Diagnostic Approach ... Clinical Findings
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... Differential Overview
Upper GI
❑ Peptic ulcer disease
❑ Gastritis
❑... DIagnostic Approach ... Clinical Findings ... Pictures
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... Differential Overview
❑ Hemorrhoid
❑ Rectal fissure
❑ Prostatitis
❑ Anal fistula ... Diagnostic Approach ... Clinical Findings
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... Differential Overview
❑ Viral gastroenteritis
❑ Staphylococcal enterotoxin
❑ E. coli
❑... Diagnostic Approach ... Clinical Findings ... Pictures
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... Differential Overview
Altered Intestinal Motility
❑ Irritable bowel syndrome
❑ Diabetic... Diagnostic Approach ... Clinical Findings
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... Hemorrhoidal varices are part of the normal anatomy. Dilation and enlargement of the superior plexus of the superior hemorrhoidal veins located above the dentate line produce... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... Also known as lazy colon, colonic stasis, colonic inertia, and atonic constipation, chronic constipation may lead to fecal impaction if left untreated. It’s... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations ... Pictures
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Diarrhea
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
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... Usually a chief sign of an intestinal disorder, diarrhea is an increase in the volume of stools compared with the patient’s normal bowel habits. It varies in severity and may be acute or... Assessment ... History ... Physical examination ... Pediatric pointers ... Geriatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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Hematochezia
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
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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... Assessment ... History ... Physical examination ... Pediatric pointers ... Geriatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
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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 acid acting on the blood as it travels through the GI tract.... Assessment ... History ... Physical examination ... Pediatric pointers ... Geriatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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... Usually a chief sign of an intestinal disorder, diarrhea is an increase in the volume of stools compared with the patient’s normal bowel habits. It varies in severity and may be acute or chronic. Acute diarrhea may... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... Constipation is defined as small, infrequent, or difficult bowel movements. Because normal bowel movements can vary in frequency and from individual to individual,... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
... READ MEDICAL BOOK EXCERPTS ONLINE » (free access, no registration)
... 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 Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... 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... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... A common symptom of anorectal disorders, rectal pain is discomfort that arises in the anorectal area. Although the anal canal is separated from the rest of the rectum by the... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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Diarrhea
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
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... Definedas stools that are more fluid and frequent than normal. Can be acute or chronic (>2–3wks in duration). Acute diarrhea is discussed in first section ofthis chapter,... Principle Causes of Acute Diarrhea ... Clinical Features and Diagnosis: Acute Diarrhea ... Diagnostic Approach: Acute Diarrhea ... Principle Causes of Chronic Diarrhea ... Clinical Features and Diagnosis: Chronic Diarrhea ... Diagnostic Approach: Chronic Diarrhea ... References
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Constipation
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
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... Constipationis difficult passage of hard stools. Clinical problem is not infrequent passageper se, but difficult and painful bowel movements. Common manifestations include crampyabdominal pain, abdominal distension,... Principal Causes of Constipation ... 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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... Usually a chief sign of an intestinal disorder, diarrhea is an increase in the volume of stools compared with the patient's normal bowel habits. It varies in severity and may be acute or chronic. Acute diarrhea may result from acute infection,... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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... Constipation is defined as small, infrequent, or difficult bowel movements. Because normal bowel movements can vary in frequency and from individual to individual, constipation is relative and must be determined in relation to the... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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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 blood as it travels through the... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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... A common symptom of anorectal disorders, rectal pain is discomfort that arises in the anorectal area. Although the anal canal is separated from the rest of the rectum by the internal sphincter, the patient... History and physical examination ... Medical causes ... Nursing considerations ... Patient teaching
... READ MEDICAL BOOK EXCERPTS ONLINE » (free access, no registration)
... 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 hematemesis—may also... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
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...
The causes of constipation can be recalled on a physiologic basis.
Normal defecation requires feces that are of proper consistency, good
muscular contraction of the walls of the large intestine,... Pictures
... 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)
...
Practically the whole specialty of proctology is devoted to taking care
of patients with rectal pain. To develop the differential diagnosis it is
useful first to divide the conditions into extrinsic and
... 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... Pictures
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... Author:
Mindy Dickerman, MD
What to Do - Gather Appropriate Data
GI bleeding can be divided into upper GI hemorrhage (bleeding proximal
to the ligament of Treitz) and... Suggested Readings
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... Author:
Laura Hufford, MD
What to Do - Interpret the Data
In newborns, one of the most common causes of blood in the stool is swallowed maternal blood. This occurs either during the... Suggested Readings
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... Maria R. Mascarenhas, MBBSKristin N. Fiorino, MD Lower GI Bleeding - BASICS Lower GI Bleeding - description Lower GI bleeding ... Lower GI Bleeding - DIAGNOSIS ... Lower GI Bleeding - TREATMENT ... Lower GI Bleeding - FOLLOW UP ... Lower GI Bleeding - bibliography ... Lower GI Bleeding - CODES ... Lower GI Bleeding - FAQ
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... Maria R. Mascarenhas, MBBSJudith Kelsen, MD Upper Gastrointestinal Bleeding - BASICS Upper Gastrointestinal Bleeding - description Vomiting of blood, whether... Upper Gastrointestinal Bleeding - DIAGNOSIS ... Upper Gastrointestinal Bleeding - TREATMENT ... Upper Gastrointestinal Bleeding - FOLLOW UP ... Upper Gastrointestinal Bleeding - bibliography ... Upper Gastrointestinal Bleeding - CODES ... Upper Gastrointestinal Bleeding - FAQ
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