Evaluation of GI bleeding

Question 1

what are the most common upper GI bleed ddx?

Answer 1

PUD
erosive esophagitis / gastritis / duodenitis
gastroesophageal varices
aortoenteric fistula

Question 2

what is dieulafoy’s lesion? where does it usually present?

Answer 2

large tortuous arteriole in the stomach wall (sub mucosal) that erodes and bleeds

upper GI

Question 3

what is the main ddx for lower GI bleed?

Answer 3

diverticulosis

Question 4

which conditions increase the rate of telangiectasias?

Answer 4

aortic valvular disease

chronic renal failure

Question 5

what is osler-weber rendu?

Answer 5

perioral petichiae

Question 6

what are predictors of upper GI source?

Answer 6

age under 50
melenic stool
BUN / creatinine ratio over 30

Question 7

when is an NG tube used?

Answer 7

when patient is vomiting blood

Question 8

what must remain in the ddx in patients with severe hematochezia, even in NG aspirate is negative?

Answer 8

upper GI bleed

Question 9

what type of fluids should be used first in large volume GI blood loss?

Answer 9

crystalloids

Question 10

what is the Hb threshold for transfusion?

Answer 10

less than or equal to 7 g/dL

Question 11

what does the AIMS65 score predict? what are the parameters?

Answer 11

predicts in-hospital mortality, LOS, cost in patients with upper GI bleed

Albumin less than 3 
INR over 1.5 
Mental status altered 
Systolic BP less than 90 
65 yo or older

Question 12

what does the Rockall scoring system predict? what are the components? what are the parameters?

Answer 12

validated predictor of mortality in patients with upper GI
bleed

clinical and endoscopic

age, shock, comorbidity

Question 13

what does the Blatchford score predict? what is it useful for?

Answer 13

predicts need for endoscopic therapy

safe discrimination of low risk UGIB patients who will likely NOT require endoscopic hemostasis

Question 14

what is the pre-endoscopic therapy for non-variceal UGIB? why?

Answer 14

IV PPIs

downstages lesion

Question 15

what therapy is recommended for most patients with acute UGIB? when must it be done?

Answer 15

endoscopy

within 24 hours

Question 16

what is the endoscopic hemostasis therapy?

Answer 16

EPI injection
thermal electrocoagulation
mechanical - hemoclips

Question 17

what are the predictors of large esophageal varices?

Answer 17

severity of liver disease (child pugh)
platelet count less than 88k
palpable spleen

Question 18

what is the main vasoconstrictor agent for variceal bleed?

Answer 18

octreotide

Question 19

what is the goal of vasoconstrictor therapy?

Answer 19

reduce splanchnic blood flow

Question 20

what reduces the incidence of bacterial infection and significantly reduces early rebleeding?

Answer 20

prophylaxis abx

Question 21

what is TIPS? what is it used for?

Answer 21

transjugular intrahepatic portosystemic shunt

treatment of gastric variceal bleeding

Question 22

what is the result of beta blockers for GI bleeding? which type of beta blocker should be used?

Answer 22

reduces risk for recurrent variceal hemorrhage

nonselective (eg nadolol)

Question 23

what is the main cause of lower GI bleed? how does it present?

Answer 23

diverticulosis

large volume, painless

Question 24

how does colitis lower GI bleed present?

Answer 24

smaller volume
pain
diarrhea

Question 25

what are the risk factors for mortality in LGIB?

Answer 25

age
intestinal ischemia
comorbid illnesses

Question 26

what is the recommended test for patients with brisk bleeding who cannot be stabilized or prepped for colonoscopy?

Answer 26

angiography

Question 27

when is CT angiogram indicated?

Answer 27

active bleeding but hemodynamically stable

Question 28

what is the indication for capsule endoscopy?

Answer 28

obscure GI bleed

Question 29

what two factors are critical to reduce mortality from UGIB?

Answer 29

early resuscitation

supportive measures

Question 30

what are the most common causes of chronic lower GI bleed?

Answer 30

neoplasm
angiectasia
IBD