2012-9-27 HISTRORY TAKING-SYMPTOMS Gastrointestinal m Coffee ground vomiting Bleeding ■ Melena SHL Hong ch as lightheadedness, syncope, angin shock Zhongshan Hospital, Fudan University Hematemesis Coffee ground vomiting a Hematemesis is vomiting of fresh blood. a indicates that active bleeding may have m Hematemesis indicates that bleeding originates from a site proximal to the ligament of Triz. A history of fresh hematemesis usually implies a significant bleed Melena Hematochezia Melena is the passage of black tarry stool when hemoglobin is converted to a Passage of pure red blood or ble a Ingestion of as little as 200ml of blood can It usually occurs when bleeding comes from the lower gastrointestinal tract. It can also present in a massive upper nall bowel or pro elena, especially when color GI bleeding2012-9-27 1 www.zshospital.com Gastrointestinal Bleeding SHI, Hong Zhongshan Hospital, Fudan University www.zshospital.com HISTRORY TAKING-SYMPTOMS  Hematemesis  Coffee ground vomiting  Melena  Hematochezia  GI blood loss frequently is occult. Sometimes, patients may present with symptoms of blood loss, such as lightheadedness, syncope, angina, or even shock. www.zshospital.com Hematemesis  Hematemesis is vomiting of fresh blood.  Hematemesis indicates that bleeding originates from a site proximal to the ligament of Treiz.  A history of fresh hematemesis usually implies a significant bleed www.zshospital.com Coffee ground vomiting  indicates that active bleeding may have ceased. www.zshospital.com Melena  Melena is the passage of black tarry stool.  It occurs when hemoglobin is converted to hematin by bacterial degradation.  Ingestion of as little as 200ml of blood can produce melenic stool.  Although melena generally connotes bleeding proximal to the ligament of Treiz, bleeding from small bowel or proximal colon may also cause melena, especially when colonic transit is slow. www.zshospital.com Hematochezia  Passage of pure red blood or blood admixed with stool.  It usually occurs when bleeding comes from the lower gastrointestinal tract.  It can also present in a massive upper GI bleeding