GI Bleeding

Question 1

What is an upper GI bleed?

Answer 1

Bleeding anywhere in the GI tract from the Pharynx to Duodenojejunal flexure or up to the ligament of Treitz

Question 2

Where is is the Duodenojejunal flexure?

Answer 2

a flexure at the junction between the duodenum and jejunum.

Supported by a suspensory muscle of the duodenum called the ligament of Treitz.

Question 3

What is a Lower GI bleed?

Answer 3

Bleeding anywhere in the GI tract that is distal to the Duodenojejunal flexure

Question 4

What are the symptoms of UGIB?

Answer 4

Hematemesis:

• “Coffee ground” emesis, indicate → light bleeding
• Bright red or dark blood, indicate → heavy bleeding

Question 5

What are the symptoms of a LGIB

Answer 5

• Melena: black, tarry, sticky, foul smelling stools
• Hematochezia: Bright red / Dark red blood in stools or blood clots

Question 6

Hematochezia might also occur in?

Answer 6

Massive UGIB

Question 7

if patient is passing dark colored stool, where the bleeding most likely coming from?

Answer 7

Ascending colon

Question 8

If patient is passing Bright red blood or stool, where is the bleeding most likely coming from?

Answer 8

Descending Colon

Question 9

What is the most common cause of a UGIB?

Answer 9

Peptic Ulcer Disease

Question 10

What are the Erosive or Inflammatory causes of UGIB?

Answer 10

1. Peptic Ulcer Diease
2. Esophagitis
3. Gastritis and / or Duodenitis

Question 11

What tumors cause a UGIB?

Answer 11

1. Gastric cancer
2. Esophageal cancer

Question 12

What are the traumatic or Iatrogenic causes of a UGIB?

Answer 12

1. Mallory-Weiss syndrome
2. Boerhaave syndrome
3. Foerign Body ingestion

Mallory-Weiss syndrome: a tear in the mucosa of the esophagus due to forceful vomiting

Boerhaave syndrome: a transmural i.e., complete tear of the esophagus due to vomiting or straing

Question 13

What are the vascular causes of an UGIB?

Answer 13

1. Gastric or Esophageal varices
2. Dieulafoy lesion
3. Angioma
4. Telangiectasias

Dieulafoy lesion: abnormally diated submucosal artery in the GI Tract, eroding overlying epithelium

Question 14

What is the most common cause of LGIB?

Answer 14

Diverticular bleeding