GI bleeding

Question 1

Common causes of bleeding: Upper GI

Answer 1

Gastritis/PUD, esophagitis
NSAID use/abuse
(Mallory-Weiss)

Question 2

Common Cause of bleeding: lower GI

Answer 2

Hemorrhoids
Angiodysplasia (vascular malformations)
Diverticulitis
Colon cancer (>60 yo)

Question 3

serious/scary causes of bleeding

Answer 3

Esophageal variceal rupture (portal HTN)
Colon cancer (any age)
Gastric cancer
Inflammatory bowel disease (Crohn’s and ulcerative colitis)
Diverticulitis
Peptic ulcer disease

Question 4

3 ways that bleeding can present

Answer 4

acute, subacute, occult

Question 5

melena

Answer 5

black stool

Question 6

“coffee ground” emesis is from what?

Answer 6

blood reacting with acid in the GI

Question 7

hematochezia

Answer 7

bright red blood (from lower regions OR from a massive & acute upper GI bleed)

Question 8

what is the “border” for upper vs lower GI regions

Answer 8

ligament of Treitz: ligament at upper/mid-duodenum

Question 9

for evaluation of GI bleed, approach depends on _______, _______, and _______

Answer 9

severity of the GI bleed, most likely source, and patient-related factors (age, current meds, etc.)

Question 10

endoscopy is the Dx procedure of choice because it can be ______ as well.

Answer 10

therapeutic

Question 11

Acute GI bleed: make sure to assess ______ ________

Answer 11

hemodynamic stability !

Question 12

variable types of anemia (usually Fe+ deficiency) can be indicative of acute or chronic GI bleed?

Answer 12

chronic

Question 13

diarrhea can indicate GI bleeding, why?

Answer 13

blood is irritating to the GI system

Question 14

general txt for upper/lower GI bleeds: acute vs chronic (weeds)

Answer 14

General treatment:
Acute– resuscitation, increase volume, RBCs, coags (FFP, PLT), NG lavage for decompression and assessment of continuing of bleeding

Chronic– D/C NSAIDs, treat H. pylori, acid suppression, control BP (varices)

Overall: acute- stabilize, chronic- txt the cause

Question 15

bright red hematemesis in pts with liver disease, what is this from?

Answer 15

varices

THIS IS A HIGH RISK CRITERIA

Question 16

hypotension, tachy, orthostasis, 4 or more unites of blood transfused in 24hours… all are ______ ______ __________ for GI bleeds

Answer 16

high risk criteria

- mean its something bad.