GI Bleed

Question 1

What is more common UGIB or LGIB

Answer 1

UGIB

Question 2

Causes UGIB

Answer 2

• Peptic Ulcer Disease- Gastric ulcers more likely to bleed >duodenal
• Esophageal varices
• Severe or erosive esophagitis
• Severe or erosive gastritis/duodenitis
• Mallory-Weiss Syndrome

Question 3

Where does LGIB originate

Answer 3

colon, distal to the ligament of Treitz

Question 4

Main cause LGIB

Answer 4

Diverticular bleed

Question 5

BRB means

Answer 5

new blood

Question 6

Coffee ground means

Answer 6

originate in stomach or upper GI and old blood

Question 7

Melena means

Answer 7

passing of black tarry stool common of GI bleed

Question 8

Hematochezia more common in

Answer 8

LGIB

Question 9

Clinical Mallory- Weiss Tear- UGIB

Answer 9

emesis, retching, coughing prior to hematemesis

Question 10

Clinical variceal hemorrhage- UGIB

Answer 10

Jaundice, weakness, fatigue, anorexia, abdominal distention

Question 11

Clinical malignancy- UGIB

Answer 11

Dysphagia, early satiety, involuntary weight loss, cachexia

Question 12

Sx prior to bleeding

Answer 12

o Painless – consider diverticular bleeding
o Change in bowel habits – consider malignancy
o Abdominal pain, diarrhea – consider colitis

Question 13

Clinical LGIB

Answer 13

• Painless bleeding most common
• May sense abdominal fullness and urge to pass stool
• Hematochezia
• Maroon colored or mixed blood with stool
• Melena (rare, may occur with right sided bleeds)

Question 14

Clinical GIB

Answer 14

• resting tachycardia, orthostatic hypotension (HR increase 20pts and systolic BP decrease 10-20mmHg)
• pale conjunctiva, pale oral mucosa, dry mucosa
• pale, grey, clammy, cool extremities
• Abdomen: normal ->distention->caput medusa->ascites - >tenderness->rebound
• Rectal: guaic + melena

Question 15

Lab GIB

Answer 15

CBC with diff – assess for anemia
- Normal initially, therefore repeat q2-8 hours
- MCV normal
- Look at HgB and Hct
CMP and LFT
- BUN –to- creatinine ratio >20:1 if actively bleeding
Coags
- INR, PT, PTT (any can be elevated)
ECG
- Assess for demand ischemia (elderly, hx CAD, chest pain, dyspnea)
- Troponins may be positive but usually due to demand ischemia
Type and Cross because may need blood transfusion

Question 16

UGIB gold standard

Answer 16

Endoscopy- Used to exclude, LGIB and unstable patients

Question 17

LGIB gold standard

Answer 17

Colonoscopy

Question 18

Tx UGIB

Answer 18

• Hospitalization
• Two large bore peripheral IV
• Type and cross for blood
• IVF resuscitation and/or blood transfusion and/or clotting factors (500mL or 2L given of IVF); give pRBC is Hgb less than 7; INR>1.5 FFP
• IV PPI BID* (Esomeprazole, pantoprazole)
• IV Octreotide* 50mcg IV bolus -> continuous infusion 50mcg/hr x3-5 days
• Reversal agents for anticoagulant or antiplatelet therapies +/-
• Prokinetic agents (e.g. erythromycin 3mg/kg IV) 30-90 minutes before endoscopic to aid in visualization
• Endoscopy (hemodynamically stable) +/- endoscopic therapy; Injection therapy (epinephrine), thermal coagulation, hemostatic clips, fibrin sealant, band 
ligation
• Rare intervention: angiography with transarterial embolization, surgical 
treatment (vagotomy, pyloroplasty, etc) – typically if failed endoscopy
  Endotracheal intubation – massive bleeding

Question 19

Tx esophageal varicies

Answer 19

• Prophylactic antibiotics – esophageal varices – broad spectrum
• Intrahepatic portosystemic shunt placement (TIPS)
• Balloon Tamponade – Blakemore tube (requires intubation)

Question 20

Tx LGIB

Answer 20

• Hospitalization
• Two large bore peripheral IV or a central line
• Type and cross for blood
• IVF resuscitation and/or blood transfusion and/or clotting factors
• Reversal agents for anticoagulant or antiplatelet therapies +/-
• Colonoscopy with therapy
• CT angiography with sclerotherapy