Evaluation of GI Bleeding

Question 1

Mediactions that you should ask about:

Answer 1

NSAIDS - promote bleeding

Question 2

Bismuth and iron medications have what side effect?

Answer 2

black poop

Question 3

Ratio of BUN to serum creatinine greater than 30 is indicative of:

Answer 3

upper GI bleed

Question 4

Factors associated with severe bleeding?

Answer 4

• red blood detected during nasogastric lavage
• tachycardia
• hemoglobin of less that 8g/dL

Question 5

Its most likely not an upper GI bleed if you find:

Answer 5

blood clots in the stool

Question 6

Predictors of upper GI bleed?

Answer 6

• history of melena
• melenic stool on exam
• blood or coffee grounds detected during nasogastric lavage
• Ratio of BUN to serum creatinine greater than 30

Question 7

How do you diagnose an Upper GI bleed?

Answer 7

upper endoscopy

Question 8

rare causes of upper GI bleed?

Answer 8

• hemosuccus pancreaticus - bleeding from pancreatic duct due to cancer or something
• aortoenteric fistua - b/w 3rd part of duodenum and aorta - usually fatal when patient has had a aorticoenteric graft = red flag for this

Question 9

usually missed lesion when doing UGI bleed:

Answer 9

Dieulafoys lesion - submucosal vessels that are de-roofed(?)

Question 10

Symptoms associated with a UGI cancer?

Answer 10

dysphagia
WL
ANEMIA

Question 11

clear out stomach - what drug?

Answer 11

erythromycin

Question 12

What does drug octreotide do?

Answer 12

decreases portal hypertensive bleed

Question 13

Give what antibiotics to help clear bacterial infections in cirrhotics?

Answer 13

cipro orceftriaxone - 20% of cirrhotics have a bacterial infection

Question 14

what is the Rockall score?

Answer 14

scale to predict chance of re-bleed

Question 15

Rockall score criteria:

Answer 15

• age
• presence of shock
• comorbidity
• diagnosis
• endoscopic stigmata of recent hemorrhage

If they look sick they will probably re-bleed

Question 16

AIMS65 is what?

What are criteria?

Answer 16

• five factors associated with increased patient mortality
  1) A-Albumin 1.5
  3) altered -M-ental status
  4) S-Systemic BP -65- years

Question 17

Causes of LGI Bleeding

Answer 17

• anatomical
• vascular
• neoplasm
• inflammatory - infectious or non-infectious like CD

Question 18

When to use an NG ?

Answer 18

massive lower bleed with upper GI source - look for bile on the NG = NOT upper GI

Question 19

Radionucleotide scanning- what is it?

Answer 19

• most sensitive test for GI bleed

- severe bleeding that cannot be stabilized for colonoscopy - localize the bleed!

Question 20

*What to do in patients with GI bleed

Answer 20

3 Rs
Resuscitate
PRBCs
risk factors

Question 21

*Patient with GI bleed… what do you do?

Answer 21

RESUSCITATE AND figure out what you need to know - then consult GI EARLY