GI BLEEDING

Question 1

initial presentation of a positive fecal occult
blood test result and/or iron deficiency anemia when there is no evidence of visible blood loss
to the patient or physician.
(Acute Upper GI Bleeding)

Answer 1

Occult gastrointestinal (GI) bleeding

Question 2

the term overt is used to describe what

Acute Upper GI Bleeding

Answer 2

blood loss that is visible to the patient or

clinician. Overt bleeding may manifest as hematemesis, melena, or hematochezia.

Question 3

what is the most common source of lower gastrointestinal blood loss, but the
bleeding is often occult
(Acute Upper GI Bleeding)

Answer 3

Colon carcinoma

Question 4

Essentials of Diagnosis

Acute Upper GI Bleeding

Answer 4

(a) Hematemesis (bright red blood or “coffee grounds”).
(b) Melena in most cases; hematochezia in massive upper gastrointestinal bleeds.
(c) Volume status to determine severity of blood loss; hematocrit is a poor early
indicator of blood loss.
(d) Endoscopy diagnostic and may be therapeutic

Question 5

what is The most common presentation of upper gastrointestinal bleeding
(Acute Upper GI Bleeding)

Answer 5

hematemesis or melena.

Question 6

Is an upper GI bleeding self-limiting

Acute Upper GI Bleeding

Answer 6

yes

Question 7

Patients with bleeding more than 48 hours prior to presentation have a low or high risk of recurrent bleeding
(Acute Upper GI Bleeding)

Answer 7

low

Question 8

Acute upper gastrointestinal bleeding may originate from what two conditions listed in the TG
(Acute Upper GI Bleeding)

Answer 8

(b) Peptic Ulcer Disease- Account for half of all major upper gastrointestinal
bleeding with an overall mortality rate of 4%.
(c) Mallory-Weiss Tears- Lacerations of the gastroesophageal junction cause 5-
10% of cases of upper gastrointestinal bleeding. Many patients report a
history of heavy alcohol use or retching.

Question 9

A systolic level of what identifies a high-risk patient with
severe acute bleeding.
(Acute Upper GI Bleeding)

Answer 9

A systolic blood pressure less than 100 mm Hg

Question 10

A heart rate over what paired with a systolic blood pressure of what
signifies moderate acute blood loss
(Acute Upper GI Bleeding)

Answer 10

100 beats/min with a systolic blood pressure over 100 mm Hg

Question 11

What systolic blood and heart rate suggest relatively minor
hemorrhage.
(Acute Upper GI Bleeding)

Answer 11

A normal systolic blood pressure and heart rate

Question 12

Is hematocrit a reliable indicator of the severity of acute
bleeding
(Acute Upper GI Bleeding)

Answer 12

Because the hematocrit may take 24-72 hours to equilibrate with the
extravascular fluid, it is not a reliable

Question 13

A nasogastric tube should be placed in all patients with suspected _____
(Acute Upper GI Bleeding)

Answer 13

active

upper tract bleeding.

Question 14

RAD / Imaging

Acute Upper GI Bleeding

Answer 14

(a) Upper endoscopy

Question 15

Labs

Acute Upper GI Bleeding

Answer 15

CBC
PT/PTT and INR
Blood type and Screening

Question 16

Patients with evidence of hemodynamic compromise are given

Acute Upper GI Bleeding

Answer 16

0.9% saline or
lactated Ringer injection and cross- matched for 2-4 units of packed red
blood cells

Question 17

NG tube placement.
Periodic reaspiration of the nasogastric tube serves as an indicator of
(Acute Upper GI Bleeding)

Answer 17

ongoing

bleeding or rebleeding.

Question 18

Pharmacologic therapy:

Acute Upper GI Bleeding

Answer 18

Proton Pump Inhibitor

Question 19

Essentials of Diagnosis

Answer 19

(a) Hematochezia usually present.
(b) Evaluation with colonoscopy in stable patients.
(c) Massive active bleeding calls for evaluation with sigmoidoscopy, upper endoscopy, angiography, or nuclear bleeding scan
(d) Diverticulosis
(e) Inflammatory Bowel Disease
(f) Anorectal Disease

Question 20

Diverticular bleeding usually presents how

Answer 20

acute, painless, large- volume maroon or

bright red hematochezia in patients over age 50 years.

Question 21

_____ should be considered for patients who have had multiple
episodes of diverticular bleeding and are good surgical candidates. (Diverticular)

Answer 21

surgery

Question 22

Brown stools mixed or streaked with blood predict

Answer 22

a source in the rectosigmoid

or anus.

Question 23

Large volumes of bright red blood suggest

Answer 23

a colonic source.

Question 24

Maroon stools imply

Answer 24

lesion in the right colon or small intestine

Question 25

Black tarry stools (melena) predict

Answer 25

a source proximal to the ligament of Treitz.

Question 26

a source proximal to the ligament of Treitz.

Answer 26

ligament of

TreitZ

Question 27

Painless large-volume bleeding usually suggests

Answer 27

diverticular bleeding.

Question 28

Labs

Answer 28

(a) CBC
(b) PT/PTT and INR
(c) Blood Type and Screen

Question 29

RAD/Imaging

Answer 29

(a) Colonoscopy

Question 30

Treament

Answer 30

a) Initial stabilization, blood replacement, and triage are managed in the same
manner as described above for Acute Upper gastrointestinal bleeding.
(b) Treating the underlying cause is the goal of therapy