26. GIB

Question 1

Hematemesis

Answer 1

Vomit blood or coffee ground

Question 2

Melena

Answer 2

Black tarry stool

Question 3

Hematochezia

Answer 3

Frank blood per rectum or red or maroon stool

Question 4

Mortality ugib vs lower

Answer 4

10%
4%

Question 5

Two big RF PUD

Answer 5

NSAID
H pylori

Question 6

Ugib originate proximal to?

Answer 6

Ligament of treitz- anchors small bowel at duodenal jejunal flexure

Question 7

Ddx ugib

Answer 7

PUD esophagitis varices
Mw test
Gastritis
Caustic ingestion
Coagulopathy

Question 8

LGIB Two main category

Answer 8

Rectal vs colonic bleed

Question 9

LGIB ddx

Answer 9

Diverticulosis
Ischemic colitis
Postpolypectomy
Hemorrhoids
Malignancy
Meckels
IBD
Angioplasia
Ulcers
Peds- anal fissure, meckel; enteric infection

Question 10

Shock index

Answer 10

Hr/ SBP to guide resuscitation

Question 11

PUD or gastritis where tender on exam?

Answer 11

Luq

Question 12

Labs for gib

Answer 12

CBC
Inr
Urea
Lactate
Cr
Bun to cr >35 90% sp id gib
T and S

ECG as ACS can oftentimes be present

Question 13

RF fib concomitant ACS

Answer 13

Diabetes
Tobacco
Liver cirrhosis
Anemia less than 90
Prior ACS

Question 14

When to cta in LGIB?

Answer 14

Stable and GI consult

Question 15

Massing gib defn

Answer 15

Ongoing bleed with shock index of 0.9 or greater

Question 16

Glasgow blatchford score what is this?

Answer 16

Assess likelihood ugib need intervention and used to predict adm

Question 17

Glasgow blatchford score indicating need endoscopy vs mortality

Answer 17

7
5

Question 18

Empiric tx gib

Answer 18

Large bore iv
2L crystalloid asap in 30 mins
Blood if massive gib
Plus or minus intubation
Imaging consult

Question 19

Concerning history in a gun

Answer 19

Over 500ml lost with symptoms of syncope confusion lightheaded dizzy and weakness
Vascular surgery abdo past
Anticoag
Lact greater than 4
Hbg <100 or decrease > 10 from bl

Question 20

Components of Glasgow blatchford scale

Answer 20

Bun
Hemoglobin
SBP
Pulse
Melena
Syncope
hepatic disease
HF

Question 21

PPI in gib

Answer 21

80 in then 40 bid

Question 22

When to use octreotide in gib?

Answer 22

Concern variceal 50 microgram blood then 50 microgram per hour

Ie hx etoh, prior varies, abnormal liver test, known liver disease

Question 23

What abx for patients with varices?

Answer 23

Ceftriaxone

Question 24

Best LR + for UGIB

Answer 24

hematemesis 5.7-7
melena hx 5.1-5.9
melane stool on exam 25.0
blood or coffee ground NG 9.6

elevated urea to Cr ratio >30:1

Question 25

Worse mortality rf in ugib

Answer 25

lact >2.5
INR >1.5
hemoglobin ?<115

Question 26

Shock index calculation

Answer 26

HR/SBP

Question 27

Name the factors of the Glasgow Blatchfod bleeding score

Answer 27

hemoglobin
bun
initial sbp
sex
HR >/=100
melena present
recent syncope
hepatic disease hx
cardiac failure

Question 28

mc lgib cause

Answer 28

diverticular disease

Question 29

Factors higher mortality in LGIB

Answer 29

hd instability
repeated hematochezia
gross blood initial rectal exam
initial hemotcrit <35%?
….