Approach to GI bleeding Flashcards
What is the anatomic dividing line of upper vs lower GI bleeding?
Ligament of Treitz
What is the minimum IV access that should be obtained with a GI bleed?
2 large bore IVs
What is a Sengstaken-Blakemore tube, and what is it used for?
Tube that is inserted in a similar manner as an NG tube. Consists of two balloons–one in the stomach, and the other in the esophagus. Used to tamponade off the bleed
What are the three major labs that should be obtained in an acute GI bleed?
CBC
CMP
PT/INR
What is the level of Hb that requires a transfusion?
7 mg/dL
What must be kept in mind about determining GI bleed based on Hgb numbers?
If acute, may not be reflected until fluids are replaced
What are the four major indications of transfusing a patient with a GI bleed (amount, Hb level, Hb rate drop, complication)?
- more than 1000 mL of bloody BMs q20-30 minutes, or an NG tube with constant bloody output
- Hb dropping 3 g/dL /2-4 hours
- Hb less than 9
- Anemia induce end organ damage
Should you reverse anticoagulation if a pt has a GI bleed?
Depends–if reverse with a mechanical heart valve, could cause clot
Why must you avoid overcorrecting HoTN in pts with a GI bleed?
HTN will cause clot instability
What is the role of NG tubes in the work up of a GI bleed?
May help to confirm UGI bleed
What are the drugs that should be administered if a patient has a confirmed GI bleed?
- PPIs or H2 blocker
- Somatostatin if variceal bleed
When should abx be given for a GI bleed?
If 2/2 liver cirrhosis
Name 3 ddx for upper GI bleed.
- Gastric ulcer
- Duodenal ulcer
- Gastritis
- Esophagitis
- Gastroesophageal varices
- Mallory-Weiss tear
- Aortoenteric fistula
- Malignancy
Name 3 ddx for lower GI bleed.
- Diverticulosis
- Meckels diverticulum
- Angiodysplasia
- Malignancy
- Colitis (due to infection , ischemia, inflammatory bowel disease)
- Anorectal (hemorrhoids, fissures)
