GI bleeding

Question 1

Name 5 causes of pediatric LOWER GI bleed

Answer 1

• Cow’s milk allergy
• Polyps
• Meckel’s diverticulum
• IBD
• Anal disease

Question 2

Name 5 ddx for lower GI bleed in adults

Answer 2

CHAND
Colitis (radiation, infectious, ischemic, IBD)
Hemorrhoids/Fissure
Angiodysplasia
Neoplastic
Diverticular disease

Question 3

Name 4 meds/foods that can mimic lower GI bleeding

Answer 3

• Iron
• Pepto Bismol
• Beets
• Liquorice

Question 4

Name two components of physical exam that should always be carried out in a patient with suspicious lower GI bleeding

Answer 4

DRE
Orthostatic vitals

Question 5

Name 8 labs for lower GI bleed

Answer 5

• Hb
• Platelets
• INR
• PTT
• Blood type + cross match
• Lytes
• Cr
• Urea

Question 6

Name 4 S+S of diverticular disease

Answer 6

• Episodic LLQ pain
• Alternating constipation/diarrhea
• Painless rectal bleeding
• Flatulence/bloating

Question 7

Name 2 management strategies for patients with diverticular disease

Answer 7

• Increase fibre in diet
• D/C NSAIDS

Question 8

Name 5 ddx for upper GI bleed

Answer 8

• PUD
• Esophageal varices
• Mallory-Weiss tear
• Erosive esophagitis
• Gastritis
• Stomach cancer

Question 9

Name the initial management steps for a patient presenting with upper GI bleeding

Answer 9

• ABCs
• 2 large bore IVs
• NG + aspiration
• Labs
• IVF (consider transfusion)
• PPI + prokinetics

Question 10

What is one scoring system to assess the severity of upper GI bleed?

Answer 10

Glasgow-Blatchford score

Question 11

Name three surgical treatments for esophageal varices

Answer 11

• Endoscopic variceal ligation
• Transjugular intrahepatic portosystemic shuynt (TIPS)
• Baloon tamponade

Question 12

What percentage of bleeds due to Mallory-Weiss tear spontaneously stop?

Answer 12

90%

Question 13

Name 4 signs of hemodynamic instability in GI bleed.

Answer 13

Hypotension, tachycardia, syncope, altered LOC.

Question 14

What is the transfusion threshold in most stable GI bleeds?

Answer 14

Hb < 70 g/L (higher threshold if CAD or ongoing ischemia).

Question 15

Name 3 features suggesting upper GI bleed.

Answer 15

Melena, hematemesis, elevated BUN/Cr ratio.

Question 16

What investigation is FIRST-line for suspected upper GI bleed?

Answer 16

Urgent upper endoscopy (EGD).

Question 17

Name 5 risk factors for GI bleed.

Answer 17

• NSAIDs
• Anticoagulants
• alcohol use
• prior GI bleed
• liver disease.

Question 18

Name 4 conditions or clinical features that may present with variceal bleeding.

Answer 18

• Cirrhosis
• alcohol use disorder
• ascites
• splenomegaly.

Question 19

What are the 3 immediate treatments for suspected variceal bleed?

Answer 19

IV octreotide, IV ceftriaxone (prophylaxis), urgent endoscopy.

Question 20

Why are antibiotics given in variceal bleed?

Answer 20

Reduce risk of spontaneous bacterial peritonitis and mortality

Question 21

What medication should be started in suspected upper GI bleed before endoscopy?

Answer 21

IV proton pump inhibitor.

Question 22

Name 4 patients with GI bleed who require urgent intervention despite not being in shock.

Answer 22

Ongoing active bleeding

Significant comorbidities

Suspected varices

Significant drop in Hb