GI Bleed

Question 1

Upper gastrointestinal bleeding is defined as hemorrhage from any source between the ______ and the _________.

Answer 1

pharynx –> ligament of Treitz

*upper MC than lower in pt presenting to emergency room

Question 2

In a pt w upper GI bleed, the stool will look how? vs a lower GI bleed?

Answer 2

• Melena (black tarry stools)… st accompanied by hematemesis
• Hematochezia

Question 3

Common Eti’s of Upper GI bleeding?

Answer 3

• PUD (50%)
• Esophagitis/varices/rupture (if varices, think cirrhosis)
• *Mallory-Weiss tears (NONTRANSMURAL TEAR)
• Boerhaave’s (tear in esophageal wall)
• Angiodysplasia
• CA

Question 4

*Glasgow-Blatchford Score is used for what?

Answer 4

screening tool to assess the likelihood that a patient with an acute upper gastrointestinal bleeding (UGIB) will need to have urgent medical intervention such as a blood transfusion or endoscopic examination

Question 5

*What markers does the Glasgow-Blatchford Score assess?

Answer 5

• Blood Urea
• Hgb (diff. for M/F)
• systolic BP
• others: pulse, melena, syncope, hepatic dz, cardiac failure

Question 6

*What does the Rockall Scoring System assess?

Answer 6

to identify patients at risk of adverse outcome following acute upper gastrointestinal bleeding – in particular, the risk of dying from an acute UGI bleed

Question 7

*What is the mnemonic used in the scoring system, Rockall?

Answer 7

ABCDE

• Age
• BP (shock?)
• Co-morbidity (ex. LR failure)
• Dx (ex. GI maligN)
• Evidence of bleeding

Question 8

*AIMS-65 criteria is used for what?

Answer 8

less expensive screening tool for predicting mortality risk from an upper GI bleed

Question 9

*AIMS-65 markers?

Answer 9

1. Albumin less than 3.0 g/dL
2. INR greater than 1.5 (clotting time)
3. Mental status changes
4. Systolic blood pressure

Question 10

*Risk Factors for increased morbidity and mortality in pt’s w lower GI bleeds

Answer 10

• poor renal fx (creatinine > 150)
• > 60 yo
• abN, low BP
• persistent bleeing within first 24hrs of presention