MLA Domain 5 · Presentation

Melaena

6 conditions in Finalist present this way. Work down the list and ask what would separate each one from the next — that discriminator is the exam question.

classic presentation · 1

Angiodysplasia

Haemodynamic compromise from acute bleeding → resuscitate as GI bleed

recognised feature · 3

Peptic ulcer disease & gastritis

ALARM features (dysphagia, weight loss, anaemia, GI bleeding, age ≥55 new dyspepsia) → urgent endoscopy

Upper GI bleeding

Shock, ongoing haematemesis, chronic liver disease (variceal), low Blatchford threshold for admission

Variceal disease

Active variceal haemorrhage → major haemorrhage protocol; high mortality

differential of the above · 2

Colorectal cancer

2-week-wait referral: age ≥40 with weight loss + abdominal pain; ≥50 with rectal bleeding; ≥60 with iron-deficiency anae

Haemorrhoids

Rectal bleeding with change in bowel habit, weight loss, anaemia, or age ≥50/≥60 → investigate for COLORECTAL CANCER, do