Black tarry stools, negative colonoscopy

[NurseyPoo7]

Had a patient today... 90-some year old, demented LOL. Came in with an H&H of around 7 & 21. Had her colonoscopy today. Of course, I am the one who gets chewed out for her not drinking her go-lytely last night. :stone

Gave her a fleets & 2 tap waters. (Why didnt they order any Senna or Dulcolax like they normally do???). By that time, it was time for her to go to the colonoscopy but was still not running clear (I made them aware before she left).

They irrigated her, cleaned her out and found a couple of polyps, a little bit of diverticulosis in one portion of her colon, no bleeding. They went ahead and did an endoscopy to check out her small bowel and found nothing there either.

Now, this morning she had a big goopy tarry black stool. I definitely thought maybe she had a bleed in her upper colon or small bowel. But no bleed was found.

How can this be? (Pt hadnt been eating anything to cause it to be dark like that and was not on an iron supplement)

[Tweety, BSN, RN]

Some GIB's are hard to find. Perhaps it had reseolved itself without current active bleeding. I would still say upper GIB with that low of the Hgb and black tarry stools.

Hopefully she'll bounce back.

[chenoaspirit, ASN, RN]

EGD's can only view the first portion of the small bowel.. the duodenum. The bleed may be in the portion that isnt viewable by a scope. Maybe they should do the pill cam. Is her H&H still dropping? If its black and tarry, its usually upper GI.

[leslie :-D]

she could have been nicked during the egd, and it passed the next day.

leslie

[nrsang97, BSN, RN]

Upper GI bleeding will cause black tarry stool. I agree that the bleed may have resolved itself and there is no further active bleeding. Also maybe the bleed is somewhere not visable by scope. EGD only goes as far as the duodenum. Could she have a bleeding scan? Deffinately Upper with the black tarry stool though.

[rintin02]

Was the black tarry stool heme positive? Because I would check her other medications. If your patient is recieving IRON then black tarry stools can be seen.

[morte, LPN, LVN]

this isnt to the point of the question, BUT, how much more do you want to put this 90 year old demented person thru????? i am not refering to the op, using the you in a general sense

[soulofme]

How can this be? (Pt hadnt been eating anything to cause it to be dark like that and was not on an iron supplement)

:zzzzz

[mshultz]

morte said:

this isn't to the point of the question, BUT, how much more do you want to put this 90 year old demented person thru????? I am not refering to the op, using the you in a general sense

I agree. If Ohio law allowed, I would have covered these "futile care" issues in my Living Will.

[Tweety, BSN, RN]

Off topic: but I'm not sure finding the source of a GIB with scopes and seeing if anything can be done is futile. Now I can see if they found a tumor, operated, and gave her chemo then yes that's futile. But cauterizing a bleed doesn't seem all that aggressive. Should we just let her bleed to death?

[morte, LPN, LVN]

Tweety said:

Off topic: but I'm not sure finding the source of a GIB with scopes and seeing if anything can be done is futile. Now I can see if they found a tumor, operated, and gave her chemo then yes that's futile. But cauterizing a bleed doesn't seem all that aggressive. Should we just let her bleed to death?

they have done the simplest, testing......the line is when you are causing the patient discomfort/pain, that they have no capacity to understand...in short the answer to your question may well be YES

[woknblues]

chenoaspirit said:

EGD's can only view the first portion of the small bowel.. the duodenum. The bleed may be in the portion that isn't viewable by a scope. Maybe they should do the pill cam. Is her H&H still dropping? If its black and tarry, its usually upper GI.

nrsang97 said:

Upper GI bleeding will cause black tarry stool. I agree that the bleed may have resolved itself and there is no further active bleeding. Also maybe the bleed is somewhere not visable by scope. EGD only goes as far as the duodenum. Could she have a bleeding scan? Deffinately Upper with the black tarry stool though.

I concur, but whattheheckdoiknow? I just had a pt that had black and tarry, we put the ngt in and out came coffee grounds. Rotated out before they had it figured out. Was found to be diabetic (pedia) during rotation.