GI Bleed

Question 1

Tx of esophageal tamponade (unstable vitals, unable to control upper GIB)?

Answer 1

A Sengstaken-Blakemore tube is inserted in a manner similar to an NG tube, and then the two balloons are inflated. The first balloon sits in the stomach and the second in the esophagus.

Question 2

Initial labs for GIB?

Answer 2

CBC, BMP, PT/PTT, type and cross

Question 3

The primary indication for blood transfusion is (general):

Answer 3

Hemorrhagic shock despite IV fluid resuscitation

• consider at Hgb 8-9
• transfuse if Hgb below 7

Question 4

Review the main indications for blood transfusion.

Answer 4

• Massive upper or lower GI bleed (e.g. passing 1000 mL maroon-colored thin liquid stools every 20-30 minutes or an NG tube with a constant output of blood )
• Hemoglobin dropping at a rate of 3g/dL over 2-4 hours in the setting of active bleeding
• Hemoglobin less than 9 in the setting of active bleeding
• Anemia induced end-organ injury (i.e. EKG changes or lab results indicating cardiac ischemia)

Question 5

_____________ or _____________ should be given to reverse Warfarin,

and __________ can be considered for reversal of aspirin or clopidogrel

Answer 5

Fresh frozen plasma (FFP) or *prothrombin complex concentrate (KCentra)

platelets

Question 6

• What medications should you start in upper GIB?

* What should you add if bleeding due to varices?

Answer 6

• PPI

- Octreotide (synthetic somatostatin) causes vasoconstriction of splanchnic blood flow

Question 7

While PPI indicated for upper GIB, when would H2-blocker be indicated?

Answer 7

Gastritis or GERD, or contra’d PPI

Question 8

When a patient with a GI bleed has a history of _________, it is recommended that antibioitcs be considered as administration of antibiotics has been shown to reduce mortality by about 20% in this condition.

Answer 8

cirrhosis

• consider ceftriaxone as first line, ciprofloxacin as second line

Question 9

Many patients who go to the ICU for GIB will need this procedure.

Answer 9

Emergent endoscopy

• May be performed in the operating room or in the ICU, or occasionally in the ED.

Question 10

Upper GIB ddx?

Answer 10

Gastric ulcer
Duodenal ulcer
Gastritis
Esophagitis
Gastroesophageal varices
Mallory-Weiss tear
Aortoenteric fistula
Malignancy

Question 11

Lower GIB ddx?

Answer 11

Diverticulosis
Meckels diverticulum
Angiodysplasia
Malignancy
Colitis (due to infection , ischemia, inflammatory bowel disease)
Anorectal (hemorrhoids, fissures)

Question 12

What is another name for prothrombin complex concentrate?

- What is this solution used for?

Answer 12

KCentra

- Recommended warfarin reversal agent