42 year old female admitted with h/o melena.... In the past 20 years before also she had hematemesis once...Now blood investigations are done... How to proceed for diagnosis...?

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Take complete history about food habits or alcohol intake.Ask for passage of frank(fresh) blood per anus.(Hematochezia) which suggest lower intestinal site.Bowel movement,weight loss,any habitual NSIAD intake, She has thrombocytopenia n Hb is 12.7 which is alright as compare to her blood loss. 1.USG abdomen to R/O cirrhosis of liver n portal hypertension 2.Upper gastroscopy(EGD Scopy) to R/O Oesophageal varies,peptic ulcer,Mallory–Weiss tears, and malignancy.  3.Stool examination for occult blood

Very well explained sir :-)

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1. ONLY UGI ENDOSCOPY should be done first to r/o PUD and we can see eso.varices on the way...rationaly nd economically i wont workup for CLD bcoz 1. by and large liver fxn is normal.. only doubt is t.bil.. reference value for T.bil for this particular lab should have been displayed.. we should know t.bil is raised or not..bcoz values mentioned in books are variable...but still it seems normal 2.GGT is raised but 2-3 times while Significant is when it is raised 4-5 times...plus ALP is not raised... so this LFT doesnt indicate a liver disease particularly CLD. .

Adv- usg abdomen to assess signs of portal hypertension with or without cirrhosis of liver. Also ugi endoscopy is indicated to rule out esophageal varies, gastric ulcers or signs of portal gastropathy. Haematologically she has only thrombocytopenia, but a platelet counts of 90000 is usually not associated with bleeding.

USG abdomen with reference to colour Doppler of portal venous system - to rule out c.L.d UGI endoscopy- to rule out esophageal varices and ulcers. Other blood tests mentioned above does not suggest as much except platelets.

It may be the case of Peptic Ulcer.So one should go for ultrasound to clarify whether abdominal lesion is there or not.

Needs get done Usg abdomen with hepatibilaty system and endoscopy to rule out ulcers and x ray p/a view

Well explained Girish sir...

Thanks. .

Trombocytopeia...symptomatic. ITP IS NOT CONSIDERED BECAUSE THE BLOOD INDICES ARE STABLE. RECURRENCE FOR 20 YRS SHOULD DIRECT OUR ATTENTION TO A POSSIBLE DRUG SHE CONSUMES OFF AND ON AND RELATION WITH DRUG.- symptom association. Further management avoid offending drug. Both upper GI and lower Gi points to a haematoligical cause if clinical and git invetigations prove negative. Finally the attempt answer this is based on my feeling that.." lesser the knowledge clearer is the thinking And less is the cofusion in mind and more freely one can talk.. with due appologies in afied where I have no bussiness.

Hahahaha...Best answer ever...

Very well explained girish sir. Thankyou


Advice UGIE with usg of whole abdoman

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