GI Bleeding

Question 1

What structure defines upper and lower GI bleed?

Answer 1

Ligament of trietz

Question 2

GI bleeding proximal to Ligament of Trietz is considered?

Answer 2

Upper Gi Bleeding

Question 3

GI bleeding distal to Ligament of Trietz is considered?

Answer 3

Lower GI bleeding

Question 4

What is occult bleeding?

Answer 4

No evidence of visible blood loss

Question 5

What is overt bleeding?

Answer 5

Blood loss that is visible

Question 6

Hematemesis that is “coffee-ground” color is likely from where?

Answer 6

Distal to the stomach

Question 7

Bright red hematemesis likely from where?

Answer 7

Proximal to lower esophageal sphincter

Question 8

Melena or dark/tar like stool indicates what?

Answer 8

Upper GI bleed

Question 9

Hematochezia or bright red blood per rectum indicates?

Answer 9

Lower GI bleed

Question 10

Melena develops after how many mL of upper Gi blood loss?

Answer 10

50mL

Question 11

What is the gold standard for definitive dx of GI bleed?

Answer 11

Upper endoscopy

Question 12

What labs can be helpful in identifying aggravating factors of GI bleed?

Answer 12

CBC, PTT, INR

Question 13

What should all patients with a suspected upper GI bleed have inserted?

Answer 13

NG tube

Question 14

What is the gold standard medication for severe upper Gi bleeds?

Answer 14

IV PPI
Omeprazole/Pantoprazole

Question 15

What percentage of Upper GI bleeds are self limiting?

Answer 15

80%

Question 16

Disposition of patients with Upper GI bleeds?

Answer 16

MEDADVICE minimum, MEDEVAC depending on presentation

Question 17

Lower GI bleeds commonly present how?

Answer 17

Hematochezia

Question 18

Common causes of lower GI bleeds?

Answer 18

Diverticulitis
IBD (UC>Crohn’s)
Anorectal Disease
Hemorrhoids
Fissures

Question 19

What 2 conditions may result in an Upper GI Bleed?

Answer 19

Mallory Weiss syndrome and Boerhaave syndrome

Question 20

How is Mallory-Weiss syndrome characterized?

Answer 20

Non-penetrating vertical mucosal tear/laceration at the gastroesophageal junction

Question 21

What causes Mallory Weiss syndrome?

Answer 21

Increase in transabdominal pressure (retching, lifting or vomiting)

Question 22

How is alcohol related to Mallory Weiss syndrome?

Answer 22

Heavy alcohol use leads to vomiting which has been noted in 40-80% of patients

Question 23

What is Boerhaave’s syndrome?

Answer 23

More severe laceration of the anterior esophagus associated with full perforation of esophagus into the mediastinum

Question 24

What is hartman’s sign in relation to boerhaave’s syndrome?

Answer 24

Crunching heard on auscultation of mediastinum

Question 25

What labs should be done for Mallory Weiss/boerhaaves?

Answer 25

CBC to r/o anemia

Question 26

What imaging should be done for Mallory Weiss/boerhaaves?

Answer 26

Upper endoscopy
CXR
Normal CXR=Mallory-weiss
Mediastinal Air= boerhaave’s