GI Bleed Lecture Flashcards
in what percentage of GI bleeds is there not a known cause?
10-15 percent
if your patient with a GI bleed presents with severe belly pain and involuntary guarding and/or rebound tenderness, what should be on top of your differential?
perforation
frank, bright red blood in the vomit is known as what? what does it usually mean?
hematemesis
active vigorous bleed
coffee ground appearing vomit would present in what type of bleed?
a slower, more limited bleed
true or false – black tarry stool (melena) indicates an upper GI bleed
false
it is NON-specific
hematochezia (bright red blood in the stool) usually indicates a lower GI bleed. what is the exception?
when accompanied by hypotension, it indicates a MASSIVE upper GI bleed
how much total volume loss usually causes supine hypotension?
40 percent total volume loss
how much total volume loss usually causes orthostatic hypotension?
15 percent total volume loss
how much blood is in a typical male’s human body? how about a female?
male = 5.6 L female = 4.5 L
what is the maximum survivable blood loss?
estimated 40 percent total volume loss
in the face of a GI bleed, you should order an _____ every 4-6 hours
hemoglobin and hematocrit
what on labs will differentiate between an upper GI bleed and a lower GI bleed?
upper GI = BUN:Creatinine ratio 20:1
lower GI not that?
does every patient with a GI bleed get a coagulation panel? how about a type and cross?
YES. everyone
how do we manage a non-urgent GI bleed? (4)
1) GI consult
2) IV PPI
3) MAYBE transfuse
4) get upper EGD today or sometime tomorrow
what is considered a GI bleed emergency?
hypotension (of any kind) + frank blood (witnessed or reported)
loaded question, but how do we manage an emergent GI bleed?
1) cardiac monitoring; frequent BP checks
2) establish 2 large bore IV sites
3) bolus IVF: at least 500cc NS
4) supplemental O2
5) IV PPI
6) prepare to transfuse
who do we always consult with when managing an emergent GI bleed? (3)
GI for urgent endoscopy
general surgery
intensivist
if a variceal bleed is high on your differential, how should you treat?
1) octreotide
2) get endoscopy
3) consider TIPS (transjugular intrahepatic protosystemic shunt) procedure
if patient’s bleed is a result of being overly anti-coagulated on coumadin, how do you treat?
1) stop the medication
2) vitamin K IV + Kcentra (prothrombic complex concentrate)
how large of a drop in hemoglobin or hematocrit is considered worrisome in the face of a GI bleed?
1 gram drop considered significant
caution: hemodilution can throw you off! correlate with symptoms
if patient is experiencing a GI bleed on one of the novel direct oral anticoagulants, what should you do?
consult the pharm D – this stuff is new and always changing
are lower GI bleeds considered more or less severe than upper GI bleeds? how do we manage them?
lower typically less severe
- manage same way as upper MINUS the PPI
- first r/o upper bleed and then get COLONOSCOPY once patient is stable and no longer bleeding. can be done outpatient
