GI Bleeding

Question 1

GI Bleeding Referral

Answer 1

All cases of GI bleed need a consult / referral to GI specialist

Question 2

Overt v Occult GI Bleding

Answer 2

Overt = visible bleeding

Occult = non-visible

Question 3

GI Bleeding Causes

Answer 3

Upper - GERD, varicies, clotting / platelet disorders

Lower - cancer, diverticulosis, polyps, colitis, ulcers, fissures, fistulas

Question 4

Esophageal varices

Answer 4

Esophageal varices are dilated submucosal veins arising as a consequence of portal hypertension.15 The most common cause of portal hypertension in the United States is cirrhosis from alcohol, hepatitis, and nonalcoholic fatty liver disease, but schistosomiasis and other parasitic diseases are common causes worldwide

Question 5

Melena

Answer 5

Melena is stool that is black, shiny, and foul smelling as a result of blood degradation. These clinical signs generally originate from an upper GI source.

Upper GI Bleed

Question 6

Hematochezia

Answer 6

Hematochezia is the passage of bright red to mahogany-colored blood from the rectum as pure blood, blood mixed with stool, blood clots, or bloody diarrhea.

Lower GI Bleed

Question 7

GI Bleeding Presentation

Answer 7

Varies based on blood loss
Tachycardia is first sign of volume loss
Patients may report blood in stool
Signs of hypovolemia occur as blood loss increases

Question 8

GI Bleed Diagnosis

Answer 8

CBC
Occult Blood Testing
Orthostatic Vitals
CT or Endoscopy
Colonoscopy

Consider coagulation studies, type/cross match, LFTs, Kidney panel