Chapter 75: Upper Gastrointestinal Bleeding

Question 1

considered the most common cause of upper GI bleeding

Answer 1

PEPTIC ULCER DISEASE

Question 2

bleeding secondary to a longitudinal mucosal tear at the gastroesophageal junction

Answer 2

MALLORY-WEISS SYNDROME

Classic History: repeated vomiting followed by bright red hematemesis.

*Associated with: Alcoholic Binge Drinking, DKA, or Chemotherapy

Question 3

arteries of the GI tract that protrude through the submucosa

Answer 3

DIEULAFOY LESIONS

most commonly found in the lesser curvature of the stomach

Question 4

Most reliable way to diagnose upper GI bleeding in the ED

Answer 4

1. Visual inspection of the vomitus for a bloody, maroon, or coffee-ground appearance
2. Visual inspection of the aspirate (NGT) for a bloody, maroon, or coffee-ground appearance

Question 5

the single most important laboratory test to obtain

Answer 5

Blood for type and crossmatch

Question 6

BUN: creatinine ratio > or = to what value suggests an upper GI source of bleeding

Answer 6

> /= 30

Question 7

TRUE of FALSE

Barium contrast studies are contraindicated in UGIB

Answer 7

TRUE

barium may hinder subsequent endoscopy or angiography

Question 8

TRUE or FALSE

nasogastric tube passage may provoke bleeding in patients with varices

Answer 8

FALSE

As of this writing, there is no evidence to support concerns

Question 9

Hgb value needing transfusion

Answer 9

<7 grams/dL

transfusing using a high threshold (hgb <9 grams/dL) can cause harm

<9 grams/dL - older patients with comorbidities

Question 10

Value for reversal theraphy in patients with coagulopathy

Answer 10

Correct if INR is elevated or Platelets < 50,000

INR ≥1.5 = predictor of mortality -> receiving anticoagulants

Question 11

Tranexamic acid in UGIB treatment

Answer 11

has been shown to reduce the risk of death in patients with upper GI bleeding

Question 12

remarks on high dose PPI

Answer 12

neutralizes gastric PH

Clot formation from platelet aggregation is dependent on a pH >6.0

Dose: 80 milligrams IV bolus followed by infusion of 8 milligrams/
proton pump inhibitors reduce the need for surgery, the length of stay in the hospital, and signs of bleeding

Question 13

Octreotide MOA

Answer 13

It inhibits the secretion of gastric acid, reduces blood flow to the gastroduodenal mucosa, and causes splanchnic vasoconstriction

dose: 50-microgram bolus then infusion of 25-50 mcg/h

Unlabeled use for varices

Question 14

When to consider giving antibiotic

Answer 14

cirrhotics with upper GI bleeding

ciprofloxacin 400 milligrams IV or ceftriaxone 1 gram IV

reduce infectious complications, rebleeding, days of hospitalization,mortality from bacterial infections, and all-cause mortality, and should be started as soon as possible

Question 15

Remarks on promotility agents in UGIB

Answer 15

Consider administration if the patient is undergoing endoscopy in the ED and the patient is suspected to have large amounts of blood in the upper GI tract

Erythromycin and metoclopramide

to enhance endoscopic visualization

Question 16

Diagnostic study of choice

Answer 16

Upper GI endoscopy

visualization of the source of bleeding (in most cases) and administration of hemostatic therapy

Question 17

When to do endoscopy

Answer 17

Stable: 12-36 hours
Unstable: 6-24 hours