Acute GI Bleed

Question 1

Presenting symptoms of various GI bleeds

Answer 1

Hematemesis - red blood in vomit, coffee grounds
melena - black, tarry stool (partially digested blood)
hematochezia - red/maroon blood in stool

Question 2

Causes of GI bleed

Answer 2

Ulcer
Esophagitis
Varices
Vascular lesions
IBD

Med related - anticoagulants, antiplatelets, NSAIDs

Question 3

PPI drug therapy

Answer 3

Use for upper GI bleeds: usually adjunct to endoscopy, good to start PPI beforehand if bleed is suspected since effect can be delayed
Acute - IV push 40-80mg q12h for 72 hr (esom, or pant)
switch to oral PPI after 72h

Question 4

Endoscopy findings

Answer 4

high risk stigmata - arterial spurting, oozing from ulcer base, visible vessel, (sometimes adherent clot)

Question 5

Managing antithrombotics

Answer 5

resume asap and use PPI
aspirin resume within 7days
if on dual antiplatelet (within 30d of stent of 90d of ACS) hold 2nd agent for up to 5 days
warfarin resume 7 days later
DOAC resume 3 days later

Question 6

Stress ulcer

Answer 6

due to reduced bloodflow, increased acid production, impaired mucosal production
50% mortality

Question 7

Candidate for stress ulcer prophylaxis

Answer 7

Highest risk (8-10%) mechanical ventilation without enteral nutrition, chronic liver disease
high risk - concerning coagulopathy, 2+ factors from lower risk
moderate risk - mechanical ventilation with enteral nutrition, AKI, sepsis, shock
low risk - critically ill patients, acute hepatic failure, steroids, anticoag, cancer, male

Question 8

Stress ulcer prophylaxis

Answer 8

happens only inpt

PPI BID x 14 days then daily with duration based on underlying cause