GI Bleed

Question 1

What is the primary indication for blood transfusion?

Answer 1

hemorrhagic shock despite IV fluid resuscitation

Question 2

Other indications for blood transfusion

Answer 2

Also, in patients with subacute bleeding and a hemoglobin of 7, or symptomatic anemia (including dyspnea, lightheadedness, and chest pain) at a hemoglobin of 8 or 9, transfusion should be considered.

Question 3

Other indications for blood transfusion continued

Answer 3

Massive upper or lower GI bleed (e.g. passing 1000 mL maroon-colored thin liquid stools every 20-30 minutes or an NG tube with a constant output of blood )
Hemoglobin dropping at a rate of 3g/dL over 2-4 hours in the setting of active bleeding
Hemoglobin less than 9 in the setting of active bleeding
Anemia induced end-organ injury (i.e. EKG changes or lab results indicating cardiac ischemia)

Question 4

GI bleed PPI for moderate treatment

Answer 4

empiric IV PPI can be started (i.e. 40 mg IV BID

Question 5

GI bleed PPI for severe

Answer 5

continuous infusion of protonix (80 mg bolus followed by 8 mg/ hour drip)

Question 6

How does Octreotide work?

Answer 6

octreotide (synthetic somatostatin) causes vasoconstriction of splanchnic blood flow resulting in decreased secretion of gastric acid and pepcin and can be administered as a IV bolus followed by an IV drip.

Question 7

Antibiotics for GI bleed and Cirrhosis together

Answer 7

20% of patients with cirrhosis and GI bleed have an underlying bacterial infection
Give Ceftriaxone