14: GIBs

Question 1

When do you give O negative blood for a bleed?

Answer 1

When pt is too unstable with ongoing bleeding -> cant wait for cross matched blood

Question 2

What does ringer’s lactate have in it that normal saline does not? (3 things)

Answer 2

1. Potassium
2. A little lactate
3. A little calcium

Question 3

Which is more likely to cause hemodynamic instability and why? UBIG or LGIB

Answer 3

UGIB - rich blood supply of upper GI tract

Question 4

What % of the time is melena due to LGIB**

Answer 4

10%

Question 5

BRBPR vs maroon blood hematochezia

Answer 5

BRB: left colon
Maroon: right colon or small bowel

Question 6

how to differentiate lower vs upper GI + where that thing is in the GI tract

Answer 6

Ligament of Treitz - between duodenum and jejunum

Question 7

Three types of meds/ingestables that you need to ask about during GIB sx that are considered “masqueraders” + why

Answer 7

1. Beta blockers: wont show hypovolemic shock sx
2. Meds with Fe or bismuth: dark stools
3. Liquid meds with red dye or foods like beets/koolaid - look like hematochezia

Question 8

What will hemoccult results be if pt is on a med with Fe or bismuth?

Answer 8

Positive

Question 9

Packed RBCs (PRBCs): function

Answer 9

Most common transfused blood product, given to increase oxygen carrying capacity of blood

Question 10

A single unit of PRBC will raise Hb and Hct how much?

Answer 10

Hb: 1g/dL
Hct: 3%

Question 11

FFP: other name

Answer 11

Fresh frozen plasma; cryoprecipitate

Question 12

FFP: function

Answer 12

Contains all coagulation factors - used to reverse warfarin with life threatening bleeding

Question 13

Platelet transfusion: when is it indicated?

Answer 13

Pts with active acute GIB + platelet count <50,000

Question 14

6 units of platelets increases platelet count how much?

Answer 14

50,000 per cubic mm

Question 15

Three ranges of Hb and whether or not transfusion is recommended

Answer 15

1. Hb <7: recommended in any case
2. Hb 8-10: not indicated unless symptomatic, ongoing bleeding, or precipitation of underlying comorbidities
3. Hb >10: not indicated except in exceptional circumstances

Question 16

What type of solutions are NS and lactated ringers?

Answer 16

Isotonic crystalloid solutions

Question 17

Why is endoscopy the gold standard for GIBs?

Answer 17

Diagnoses and can treat the source of bleeding

Question 18

Three methods of endoscopic hemostasis

Answer 18

1. Injection: vasoconstrictors, saline, adhesives
2. Thermal therapy: cauterized vessels
3. Mechanical therapy: hemoclips or rubber glands to close vessels

Question 19

What does TIPS stand for?

Answer 19

Trans-jugular intrahepatic Portosystemic shunt

Question 20

How does TIPS procedure work?

Answer 20

Creates a low-resistance channel between hepatic vein + intrahepatic portion of portal vein -> decreases portal HTN to prevent varices

Question 21

Colonoscopy for diverticular bleed

Answer 21

Can try to localize a particular bleeding vessel and treat it, but is sometimes difficult to ID bc of how many diverticuli + there may be multiple bleeding at once

Question 22

Most common cause of slow occult LGIB

Answer 22

Colon carcinoma