What specific sign on the physical exam is characteristic of upper digestive sys

Question

What specific sign on the physical exam is characteristic of upper digestive system bleeding?

Case Study

Personal Information

Name: Mr. Christopher Franklin

Age: 60 years old

Gender: Male

Description

Mr. Franklin is a 60-year-old patient with a history of a thrombotic cerebrovascular accident two years ago. After the stroke he started with seizure attacks. He has been suffering from hypertension for the last ten years and ulcerative colitis since last year. He currently takes lisinopril, hydrochlorothiazide, aspirin, carbamazepine, and a low dose of prednisone.

Mr. Franklin has been suffering from epigastric pain, sensation of fullness, and occasional nausea for the last six months. This time, he was brought to the ER because, while he was talking to his son, he had a dizzy spell and fell to the floor. He is conscious and is complaining of severe epigastric pain. He began with mild abdominal pain two days after he started taking a new cycle of prednisone for his colitis, around seven days ago. The pain increases when he eats or drinks something. He is also complaining of suffering from pyrosis, malaise, and dizziness, and he has noticed that his feces are dark.

The patient was a heavy alcohol drinker until he had the stroke. He is a cigarette smoker since he was 20 years old. His mother suffered from Alzheimer’s disease and died of colon cancer, and his father died of cirrhosis of the liver.

On physical examination we found:

Remarkable Signs on Physical Exam by Regions

Abdomen: Pain on palpation on epigastric region

SOMA: Right hemiplegia and hyperreflexia

Remarkable Signs on Physical Exam by Systems

Integumentary system: Pallor, diaphoresis, coldness

Cardiovascular system: Tachycardia. Blood pressure 70/50 mmHg. Radial pulse 110.

Digestive system: Tenderness of epigastric region. Rectal exam showed melena.

Neurologic system: The patient is conscious and well oriented to time, place, and person. Right hemiplegia and hyperreflexia.

Lab Tests

Complete blood count (CBC)

Metabolic panel

Lipid panel

Abdominal CT scan

Esophagogastroduodenoscopy

Main Diagnosis

Upper digestive bleeding due to drug-induced gastritis

Hypovolemic shock

Acute anemia

Other Diagnoses

Stabilized thrombotic cerebrovascular accident

Epilepsy

Essential hypertension

Ulcerative colitis

Explanation / Answer

Digestive system is one of the major part of our body, which balances all the nutrients and also helps in digesting foods. The digestive tract consists of esophegus, stomach, small intestine etc. The bleeding in upper digestive system may be due to many reasons such as drug induced or many other causes. The symptoms includes are vomiting, indigestion problem, anemia, fatigue, blood in stool etc.

These are the physical examination through which one can know about the upper digestive system bleeding. The more symptoms are this bleeding is always followed by hematemesis.

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