GI bleed disorders

Question 1

List the top three causes of acute upper GI bleed.

Answer 1

1. Peptic ulcer disease: 50+%
2. Portal hypertension, usu. esophageal varices: 10-20%
3. Mallory-Weiss tears: 5-10%

Question 2

Within 24 hours, you should perform this procedure on all patients with upper GI bleeding.

Answer 2

Upper endoscopy
~to identify source of bleed
~to render endoscopic therapy

Question 3

What are two things you can do to help determine the severity of an acute upper GI bleed?

Answer 3

1. assess hemodynamic status:
~SBP < 100 = high risk, severe bleeding
~HR > 100, SBP > 100 = moderate blood loss
~normal SBP & HR = minor
2. nasogastric tube: aspirate contents
~"coffee grounds" confirms upper GI bleed
~bright red blood = active bleed
~clear = low risk

Question 4

List the top three causes of acute lower GI bleed.

Answer 4

1. Diverticulosis
2. Unknown
3. Hemorrhoids

Question 5

How is lower vs upper GI bleed defined?

Answer 5

Above ligament of Treitz (duodenum and proximal): upper

Below ligament of Treitz (jejunum and distal): lower

Question 6

What is the definition of occult bleeding in an adult?

Answer 6

positive FOBT/FIT or iron deficiency anemia in the absence of visible blood loss

Question 7

In an asymptomatic adult with a positive FOBT/FIT, what is the next step?

Answer 7

colonoscopy