Evaluation Of GI Bleeding

Question 1

manifestations of upper GI bleed

Answer 1

1. hematemesis
2. coffee ground emesis
3. melena
4. hematochezia

Question 2

When “assessing hemodynamic status” you are looking at?

Answer 2

BP
HR
orthostatic changes

Question 3

This lab value is a poor early indicator of bleeding because it takes 72 hours to equibrilate and people are losing whole blood in GI bleeds

Answer 3

hemoglobin

Question 4

For cirrhotics with GI bleeds, we highly recommend they also take

Answer 4

antibiotics to reduce infection

octreotide (vasoactive drug) to control bleed long term

Question 5

When to scope patients based on risk?

Answer 5

Hospitalized: within 24 hrs
Low risk: ASAP to send them packing
High risk: within 12 hours once stable

Question 6

common causes of upper GI bleed

Answer 6

ulcer
varices
mallory weiss tears
erosions
erosive esophagitis

Question 7

Rank ulcers from best case to worst case scenario

Answer 7

clean base > flat spot > clot > visible vessel > active bleed

Question 8

Why give PPI in GI bleed?

Answer 8

theory is that decreasing acid improves the ability of clots to form and clot stability. must be potent therapy (IV bolus continuous)

Question 9

PPI recommendations for GI bleeds

Answer 9

IV PPI bolus with continuous infusion for high risk lesions

Standard oral PPI for low risk lesions

Question 10

What are important steps to take in terms of medications and steps going forward when assessing GI bleeds?

Answer 10

r/o or treat H pylori, then stop PPI
stop NSAIDS
Stop aspirin for primary prevention
resume in 1-7 days if secondary prevention and stay on PPI

Question 11

management of an acute variceal bleed

Answer 11

ligation and octerotide injection at site

TIPS if high risk

Question 12

What can you do to prevent recurrence of variceal bleed?

Answer 12

beta blocker

ligation

Question 13

What are hemorrhoids

Answer 13

varicose veins of anus/rectum

Question 14

What causes hemorrhoids

Answer 14

being pregnant, 
constipated
portal HTN
obese
sit for long time
anal sex

Question 15

Diverticular hemorrhage

Answer 15

path: arteriole in diverticula
pt: over 50, painless BRBPR
dx. colonoscopy
tx; hemicolectomy- resection

Question 16

what are AVM?

Answer 16

superficial feathery vessels

Question 17

what is a dieulafoy lesion?

Answer 17

normal variant of antomy where artery is at surface of mucosa
patient has painless upper GI bleed
need to resect it

Question 18

generalized GI bleed treatment options

Answer 18

IV fluids large bore needle
IVF
IV PPI
type/cross
call GI

if cirrhotic: octerotide plus ceftriaxone