GI Bleeding

Question 1

Who gets GI bleeds more often? Men or women

Answer 1

Men>Women

Question 2

Most common cause of UGIB? Which location is more common?

Answer 2

PUD.

Gastric>Duodenal

Question 3

Two types of UGIB associated with vomiting

Answer 3

Boerhaave and mallory weiss syndrome.

Question 4

What is Boerhaave syndrome?

Answer 4

Spontaneous transmural rupture of the esophagul after forceful emesis. Scary shit, this kills you. MW is so not a big deal in comparison

Question 5

What is the dividing line between UGIB and LGIB

Answer 5

Ligament of treitz

Question 6

Most common cause of LGIB

Answer 6

Diverticular bleed

Question 7

Which kind of GIB is more likely to stop spontaneously?

Answer 7

LGIB. 80-85% of the time

Question 8

Typical primary WU of a GIB

Answer 8

Hx, PE, Labs

+/- NGT, this can piss off varices

Diagnostic studies (we’ll get into this)

Question 9

Hx associated with a UGIB

Answer 9

Hemesis. BRB or coffee ground. Melena

PMH: of etoh, pregnancy, pud, GERD, liver cirrhosis, h pylori
Comorbid: CAD, CHF, RF, coagulopathy
Rx: NSAID, PPI, anticoag

Question 10

Clinical manifestation of UGIB

Answer 10

Depends on the cause.

PUD? Epigastric/RUQ pain
Esophageal ulcer: GERD, dyaphagia
MW: Emesis, retching, coughing prior to hematemesis
Variceal: Jaundice, weakness, fatigue, ascites
Malignancy: dysphagia, involuntary weight loss, cachexia

Question 11

Sx assoc with severe bleeding in UGIB

Answer 11

Hypovolemia sx. Orthostatic dizziness, confusion, angina, palps

Question 12

Determining cause of LGIB by hx

Answer 12

Look at the symptoms prior to the bleeding!

Question 13

LGIB- painless hx. Likely cause?

Answer 13

Diverticular bleed

Question 14

LGIB- change in bowel habits hx. Likely cause?

Answer 14

Malignancy

Question 15

LGIB- hx of abdominal pain & diarrhea. Likely cause?

Answer 15

Colitis

Question 16

Clinical manifestation of LGIB

Answer 16

Painless bleeding most common! (Since diverticular is most common)
May sense fullness and need to pass stool

Hematochezia (BRBPR)

Melena is rare, more associated with UGIB. May occur if R sided bleed

Question 17

GIB Labs to get

Answer 17

CBCw/diff
CMP (BUN/Cr)
COAG
ECG (for demand ischemia in elderly & hxCAD)

Question 18

Why do we want a CMP in a GIB

Answer 18

BUN/Cr >20:1 suggests prerenal ischemia.

Question 19

Diagnostic studies for GIB (and GS for UGIB and LGIB)

Answer 19

UGIB GS- Endoscopy. Can diagnose and treat

LGIB- Colonoscopy technically. But hard to do acutely.

We also have CT angio sclerotherapy, tagged RBC nuclear scan for LGIB (since cscope can be hard to do)

Question 20

Role of nasogastric lavage in GIB

Answer 20

Controversal. Can tell us whether the bleeding is active or not for an UGIB, but if the patient has varices it can end poorly

Question 21

Rx to give in acute UGIB

Answer 21

IV PPI (-prazole)
IV Octreotide (transient reduction of Portal HTN)

Reversal agents (platelets, desmopressin)

Question 22

UGIB management once hemodynamically stable

Answer 22

Endoscopy, treat it right then and there. Injection therapy, coag, band ligation.

Question 23

Use of prokinetic agents prior to endoscopy for UGIB

Answer 23

Cause the contents of the stomach to empty faster, aids in visualization. Give 30-90 minutes before EGD.

Metoclopramide or erythromycin

Question 24

UGIB pt failed endoscopy?

Answer 24

Angiography ww/ transarterial embolization. Last resort

Question 25

UGIB w/ massive bleeding? Airway?

Answer 25

Must intubate. Esp if considering using a balloon

Question 26

Management of variceal UGIB in the acute/nonhemodynamically stable setting

Answer 26

Ppx broad spectrum abx for

TIPS to reduce pHTN

Balloon tamponade to get them thru the day

Question 27

Do Xa inhibs have a reversal?

Answer 27

Heck no! But KCENTRA partially reverses them so that’s nice.

Question 28

Indications for hospitalization in LGIB

Answer 28

Hemodynamically unstable
Age
Combordities