G.I. Bleed

Question 0

Basic steps in a patient vomiting blood?

Answer 0

#IV access/type and cross
#Don't necessary need NG tube to confirm G.I. bleed
#Endoscopy

Question 1

Primary Sources of G.I. bleed? Percentages?

Answer 1

75% – upper G.I. tract
25% – colon/rectum
Few – jejunum/alien

Question 2

Workup of red blood per rectum?

Answer 2

1. IV access, type and cross
2. NG tube to aspirate gastric contents
   #If upper source, endoscopy
   #If aspirate is white, duodenum still potential source, use endoscopy
   #If green, entire upper G.I. is excluded
3. Anoscopy to rule out bleeding hemorrhoids
   #Angiogram with embolization if bleeding exceeds 2 mL/min
   #Tagged RBC study if bleeding between .5 and 2 mL/min

Question 3

Patient presents with recent history of blood per rectum, but not actively bleeding – work up?

Answer 3

#Upper endoscopy if young
#Upper and lower endoscopy if old

Question 4

Blood per rectum in a child – suspected diagnosis? Work?

Answer 4

Meckel’s diverticulum; technetium scan

Question 5

Massive upper G.I. bleeding in patients with multiple trauma – suspected diagnosis? Confirm with? Best therapeutic options?

Answer 5

Stress ulcers; endoscopy;

Angiographic embolization and maintenance of gastric pH over 4