GI Bleeding to include Hematemesis and rectal bleeding

Question 1

The ______ is the anatomical landmark that defines the border between the upper and lower GI tract.

Answer 1

Ligament of Treitz

Question 2

_______ = the vomiting of blood

Answer 2

Hematemesis

Question 3

_______ = blood loss that is visible to the patient or clinician

Answer 3

Overt

Question 4

If there is hematemesis that is of a “coffee-ground” black color, it is likely
that the origin of the bleed is _______ to the stomach, as the blood had
to have interact with __________.

Answer 4

• At or distal to the stomach

- gastric acid

Question 5

When the blood in the hematemesis is bright red, it indicates the iron in the
hemoglobin has not interacted with gastric acid, and therefore the bleed is
likely to be where?

Answer 5

at or proximal to the lower esophageal sphincter

Question 6

_______ is a “tar-like” coloration of stool

This indicates a ____ GI bleed as the iron in the hemoglobin has interacted with _____, turning the iron black

Answer 6

• Melena
• upper GI bleed
• gastric acid

Question 7

________ is bright red blood in the stool

Indicative of a likely ______ GI bleed, as the iron in hemoglobin has not interacted with ______.

Answer 7

Hematochezia
lower GI BLEED
gastric acid

Question 8

What are the two Most Common presentations of upper GI bleed

Answer 8

Hematemesis

Melena

Question 9

Melena: develops after as little as ___mL of upper GI blood loss

Answer 9

50

Question 10

If the upper GI bleed is massive (>1000mL) what may present?

Answer 10

hematochezia

Question 11

RAD/Imaging upper GI

What is the gold standard for definitive diagnosis and can be therapeutic.

Answer 11

Upper Endoscopy

Question 12

Labs are of little value in the diagnosis of upper GI bleeding. Why?

Answer 12

Hematocrit takes approximately 24-72 hours to equilibrate making it of little use for the diagnosis of an acute GI bleed.

Question 13

What should be inserted into all patients with a suspected active upper GI bleed?
1) Can be diagnostic and therapeutic.
2) The aspiration of red blood or “coffee grounds” confirms an upper
gastrointestinal source of bleeding.
3) However, 10% of patients with a confirmed upper GI bleed will have non-bloody aspirate.
a) Typically these patients have bleeding originating distal to the pyloric
sphincter

Answer 13

Nasogastric (NG) Tube Placement

Question 14

Management upper GI
(a) Assess hemodynamic status
Systolic blood pressure (SBP)<100 mmHg identifies a patient who has sustained what?

Answer 14

severe blood loss (30-40% of circulating blood volume).

Question 15

Management upper GI
(a) Assess hemodynamic status
Heart Rate (HR)>100 bpm with SBP>100mmHg is indicative of

Answer 15

moderate blood loss (15-29% of circulating blood volume).

Question 16

Management upper GI
(a) Assess hemodynamic status
SBP and HR within normal limits is indicative of

Answer 16

minimal blood los

Question 17

upper GI

A patient who has sustained severe blood loss (30-40% circulating blood volume) requires what?

Answer 17

intravascular volume replacement.

Question 18

Pharmacotherapy upper GI

What are the gold standard medication of choice for severe bleeds?

Answer 18

IV Proton Pump Inhibitors (PPIs)

Question 19

Pharmacotherapy upper GI

If a patient is tolerating oral intake, what may be appropriate for long term care?

Answer 19

PO PPI

Question 20

Disposition
(a) Upper gastrointestinal bleeding is self-limited in __% of patients.
(b) Urgent medical therapy and ______ evaluation are obligatory in cases that do
not resolve spontaneously.
(c) A patient with a suspected upper GI bleed will necessitate a MEDADVICE call at a
minimum, but may need a MEDEVAC depending on the patients presentation and
response to treatment.

Answer 20

a) 80%

b) endoscopic