Clinical Approach to Stable Upper GI Bleeding!
March 5, 2020
Please help me. What’s wrong? I need a Doctor. You need a dry cleaner not a Doctor. Come here. Are you a Doctor? What do you think?!!! Forgive me. What is the wrong with you? I vomited some blood. [KNOCKING] Peace be upon you Why all the noise? What!!! What are you doing?!! Are you sleeping? This is a medical clinic not your home. I am sorry. Forgive me. I have pizza order for Dr. Hossam. Are you Dr. Hossam? [Hey, Dr. Sherif] Yes, I am. Give me 50 pounds. What!! 50 Pounds. Aren’t you that news presenter from the TV? ohhh You present the news, right? How did you know? I watched you. Really!! What do you think? I swear I watch you only. Really you made my day. I swear. I love you dude. I must hug you. Come on. Let’s take a selfie together. [Shooting] You are so cool. Thank you Doctor. My wife will be amazed. She likes you alot. May God save you. You are a celebrity. God be with you Thank you. Bye. What a fool!! He forgot about the money. Are you married, Doctor? Why are you still here?!! You can go. Is there anything else, Doctor? Do you envy me for the pizza? I can’t agree more What!! Goodbye. God be with you. Stop laughing at me. [cough] It’s only little blood and it will get better. I knew I didn’t need a check up. Dr. Sherif. What a great man. Dr. Sherif !!! What is this Doctor.. I was leaving and Dr. Sherif said I was okay. First, I want you to forget anything that happened in the last 15 minutes. Now, tell me what happened to you. I vomited some blood at home. Dr. Sherif said I am okay and I can go. o0o0o Dr. Sherif. Just take a rest until I come back. It is really useless, it’s only little blood. Wow it’s a patient. What is this? Are you dying? Is it blood? Dying!! What is the wrong with you? What happened? Only some blood. Am I dying? How did it happen? From my mouth. What is this? What are you doing here? Am I dying, doctor? Please Doctor, let me examine him. Atleast before he dies. Do you think that you are qualified?!! It’s easy. We need to help him before he dies. Go and bring the other Doctor. Okay. Am I going to die, Doctor?!! Die? What? ♫ I was studying all my life. I had great ambition ♫ ♫ I studied, my dream came true. I succeeded and got my degree. I got the highest position and now I am an anesthesiologist ♫ What is this? Do you think your appearance is appropriate for a Doctor? Orange shorts!! Pony-tail !! Really!!! Excuse me Doctor, you can evaluate my knowledge, but commenting on my looks isn’t acceptable. Knowledge? Do you think yourself to be like the famous Dr. Magdi Yacoub?!! Yes yes. Okay come in. Show me. Dr. Sherif examined you then he dismissed you? Right? Yes. God bless Dr. Sherif. But this Doctor grabbed me as I was leaving to see me again. Am I going to die, really? Actually, most cases of upper GI bleeding are stable and resolve spontaneously. But a minority of cases can progress from presentations like this patient’s to massive upper GI bleeds. So here our job is to try and distinguish these cases before they progress to massive upper GI bleeding. We are going to take history and make investigations. What will we do, Doctor? hmmmm We have his name and age, we can ask him which type of contracept…(stops) WHAT!!! Ok never mind, I don’t need this paper. This patient is completely stable. Are you okay now? I am okay. You don’t feel any pain, Right? Correct. Is this history taking?!! And investigations, Doctor? This is easy. What do you take me for? A petroleum engineer? I am a masterful Doctor. What you gonna do Doctor? This is called hygiene. It is important to take a sample and taste. If it is sour we know that this blood or ketchup. Whatever it is, it tastes bad. His condition is bad. Now my masterpiece, GI bleeding means percussion. Excuse me dude. Wow. What is this? Is this an investigation? This is percussion. Are you serious? It is to make patient relaxed. We learnt it. Ok. We must decide what labs this patient needs. yeah right Okay. Now how are we going to decide if this patient can be safely discharged? This my field of study. I learned it in Tibet. In Tibet they taught us. What do they do there? They taught us that human internal energy can tell you everything without lab test. Like this, we try to withdraw all the negative energy, all his problems and worries. We absorb them. So we know whether the patient can be part of our hospital and our group. Energy?!! Yes. Haven’t you heard about this scoring system? Sure it’s known. Okay how do you perform it? We will score him. Great, score me. Based on what? We will do lab tests. We measure hemoglobin, BUN and systolic blood pressure. In addition to HR and if melena is present. This tool can help us decide whether the patient needs to be admitted. You will pass my friend. What do you think? Sure thing. So what some medications we can use to treat patients? Yes, Doctor? Acupuncture and herbals. Are we in a herbal store? Acupuncture? Seriously? Two of the most serious causes of bleeding are varices and peptic ulcers. She didn’t study well. Right? Ok. With that knowledge. Now one of you take the patient’s history and the other do the lab tests. okay What is happening?