Gastrointestinal Bleeding

Question 1

can see black dotted stools

Answer 1

Overt Bleeding

Question 2

not able to see source of bleeding on endoscopy/colonoscopy

Answer 2

Obscure Bleeding

Question 3

need to test the stool to find blood

Answer 3

Occult Bleeding

Question 4

• ULCERS
• TEARS
• ANGIOECTASIAS
• TUMORS

Answer 4

Non-Variceal Bleeding

Question 5

• portal HTN causes backward pressure
• commonly due to advanced cirrhosis or continued alcohol use
• ESOPHAGEAL VARICES: via coronary vein
• GASTRIC VARICES:
  
  • greater curvature via splenic vein

Band ligation only for esophageal varices, not gastric varicose

Answer 5

Variceal bleeding

Question 6

• most common cause of GI bleeding
• Gastric ulcers are the most common within the GI
• Most commonly caused by H. pylori or NSAIDs

Answer 6

Ulcers

Question 7

• Curved gram-negative rod
• Diagnose by testing for urease (breath test)
• CagA protein: associated with more inflammatory-type ulcer
• Triple therapy to eradicate: proton pump inhibitor, clarithromycin, amoxicillin (or metronidazole)

Answer 7

H.pylori

Question 8

passage of fresh blood through the anus, usually in or with stools
- Usually associated with lower GI bleeds, but can be due to upper GI bleeds

Answer 8

Hematochezia

Question 9

• Take vitals and start resuscitation (irrespective of cause/source of bleeding) prior to endoscopy, etc.
• Have 2 large IV fluid bags on hand to restore blood volume
• Protect patient’s airway: don’t want Pt to aspirate blood, especially nasogastric aspirate
• If tachycardic and hypotensive (loss of >1L of blood): ICU
• if Young patient w/ minor bleeding, no anemia: Outpatient

Answer 9

Initial Management of UGIB

Question 10

Injection: Epinephrine

Cautery: heat/laser

Mechanical: banding

Answer 10

Endoscopic hemostasis

Question 11

• longitudinal mucosal lacerations at the gastroesophageal junction due to severe vomiting/retching
• leads to hematemesis
• usually found in alcoholics or bulimics

Answer 11

Mallory-Weiss Syndrome

Question 12

Vomiting of blood

Answer 12

Hematemesis

Question 13

• a large tortuous arteriole in the stomach wall that erodes and bleeds
• M:F 2:1

Answer 13

Dieulafoy’s Lesion

Question 14

• Diverticulosis

- Angiodysplasia

Answer 14

Lower GI Bleeds

Question 15

• Outpouschings of mucosa and submucosa through the muscular is propria (a pseudodiveritculum)
• associated with constipation, straining, and low-fiber diet
• Can cause rectal bleeding/hematochezia
• commonly seen in older adults
• Sigmoid colon is the most common location

Answer 15

Diverticulosis/Colonic Diverticula

Question 16

Acquired malformation of mucosal and submucosal capillary beds
- reputure classically presents as hematochezia in older adults

Answer 16

Angiodysplasias

Question 17

• black, “tarry” feces that are associated with gastrointestinal hemorrhage
• black color is caused by oxidation of the iron in hemoglobin during its passage through the ileum and colon

Answer 17

Melena