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(Paeds) Approach to PR bleed (True PR bleed? haemoptysis/ epistaxis …

- - - - painful
        
        external haemorroids
        
        anal fissure
      - painless
        
        internal haemorrhoids
        
        rectal varices
  - - - (fresh red blood only) mallory-weiss tear/ boerhaave syndrome
      - PUD
        
        FOBT/anaemia, worse/better with food, LOW/gain weight, epigastric pain
        
        RF: alcohol/smoking, H. pylori, NSAIDs
        
        cx: gastric cancer
      - gastritis (endoscopic diagnosis)
        
        indigestion, bloatedness, abdo pain, N/V
        
        RF: NSAIDs, alcohol
      - gastric ca/ polyps
        
        mets: colon, liver, spleen, peritoneum
        
        RF: smoking, diet (preserved, smoked), H. pylori, family hx
      - dieulafoy's lesion
      - esophagitis (NSAIDs/KCl/tetracyclines/bisphosphonates, HIV)