gi bleed

Rectal Bleed – Low Risk

MDM

This patient has a presentation consistent with rectal bleeding, most likely due to ***. Differential diagnosis includes ***. Low suspicion for hemorrhoids (external or internal, including thrombosed hemorrhoids), rectal ulcer (HIV, syphilis, STI) or rectal foreign body. Presentation not consistent with other acute, emergent causes of upper or lower GI bleeding. No evidence of hemorrhagic shock.

Plan to check labs to evaluate the extent of bleeding, including H/H. No indication for abdominal imaging at this time.***

Plan: CBC, serial reassessment, PMD / GI referral

Lower GIB – General

MDM

This patient presents with symptoms concerning for a lower GI bleed. Differential diagnoses include diverticulitis (most common cause) versus hemorrhoids. Less likely etiologies include angiodysplasia, cancer, IBD. Presentation not consistent with mesenteric ischemia or ischemic colitis, brisk or life threatening upper GIB as patient has no evidence of hemorrhagic shock. Plan to check labs to evaluate the extent of bleeding, including H/H. Will consent patient for blood and transfuse to goal Hb of >7 if necessary. No indication for abdominal imaging at this time.***

Plan: labs, LFTs, close hemodynamic monitoring, serial reassessment, CT AP***