Week 3: GI bleeding

Question 1

appearance of output from GI tract to localize bleeding and approximate rate

Answer 1

Upper GI: esophagus, stomach duodenum
middle GI: jejunum, ileum
lower GI: Colon
1. Hematemesis: brisk upper GI bleed
2. Melena: slower Upper GI bleed, or less commonly small bowel or right colon bleed
3. Hematochezia: colonic bleed or rapid upper GI or small bowel bleed

Question 2

High risk peptic ulcer bleeding

Answer 2

-endoscopic therapy combined with PPI inhibitors

Question 3

Variceal bleeding

Answer 3

• esophageal: can be treated by octreotide (somatostatin) and endoscopic ligation (or beta blocker for vasoconstriction, but it lowers bp)
• gastric varices more difficult to manage. TIPS is first line.

Question 4

Lower Gi bleeding

Answer 4

• diverticular bleeding and vascular ecstasies are most common. ischemic, radiation, infectious, inflammatory colitis are low volume bleeds. Hemorrhoids and fissure.
• therapeutic colonoscopy- controversial
• upper endoscopy to rule out upper GI bleed. Non emergent colonoscopy to confirm diagnosis.