DIAGNOSIS CHECKLIST
for Gastrointestinal bleeding

Why: oral iron therapy , bismuth-containing antacid tablets and charcoal ingestion can cause black colored stool and be confused with the black tarry stool due to gastrointestinal hemorrhage; Aspirin, non-steroidal anti-inflammatories, anticoagulant therapy, reserpine, caffeine and high dose corticosteroids can increase risk of upper gastrointestinal bleeding.

Why: Alcohol induced cirrhosis can increase the risk of peptic ulcers, gastro- esophageal varices.

Why: colon or rectal cancer; bleeding disorders, inflammatory bowel disease, peptic ulcer.

Why: some foods can cause black-colored stool and are not true melena e.g. red wine, licorice, beetroot.

Why: to determine if true melena ( black tarry sticky stool with strong odor) due to gastrointestinal hemorrhage - usually suggests bleeding from the upper gastrointestinal tract e.g. peptic ulcer, esophageal varices, erosive oesophagitis, stomach cancer.

Why: suggests bleeding from the esophagus, stomach, duodenum e.g. esophageal varices, peptic ulcer, gastritis.

Why: suggests bleeding from the distal colon or rectum, or from a major bleed higher in the gastrointestinal tract e.g. diverticular disease, bowel cancer, hemorrhoids, inflammatory bowel disease, colonic polyp.

Why: may be signs of shock and thus indicate a sudden loss of blood volume.

Why: may suggest oesophagitis.

Why: may suggest oesophagitis or peptic ulcer.

Why: suggests peptic ulcer, oesophagitis, gastritis, stomach cancer.

Why: may suggest oesophagitis (especially if with hot and cold fluids) or stomach cancer.

Why: may suggest stomach cancer, chronic gastritis, bowel cancer, inflammatory bowel disease.

Why: purpura ( multiple small hemorrhages into the skin or mucous membranes); petechiae (small pinhead size purpura); ecchymoses ( large purpura) - may suggest a bleeding diathesis.

Why: e.g. early satiety, loss of appetite, weight loss.

Why: e.g. intermittent symptoms of gnawing or burning-type pain in the epigastrium (midline, under the ribs) which can be located by finger point, pain is worse before meals and relieved by taking antacids or food. Pain may waken the person at night.