GI bleeds

Question 1

Upper gastrointestinal bleeding (UGIB)
The source of the bleeding is proximal to the

Answer 1

ligament of Treitz

Question 2

___ bleeding: maroon, jelly-like traces of blood in stools

Answer 2

Colonic

Question 3

___ bleeding: streaks of fresh blood on stools

Answer 3

Rectal

Question 4

Both melena and ___ can be caused by either UGIB or LGIB.

Answer 4

hematochezia

Question 5

Unexplained __ should raise suspicion for GI bleeding
in all patients (Especially, elderly)

Answer 5

iron deficiency anemia

Question 6

BEST 1st step in management of active GI bleeds
All patients: ____

Answer 6

2 large-bore peripheral IVs
(for IVFs +/- transfusion)

Question 7

Imaging for suspected UGIB in hemodynamically stable patients

First line:

If negative:

Answer 7

First-line: EGD
EGD negative: colonoscopy

Question 8

Imaging for suspected LGIB in hemodynamically stable patients

First-line:

if negative:

Answer 8

First-line: colonoscopy (bowel prep)

Colonoscopy negative: EGD

Question 9

Imaging for suspected UGIB in hemodynamically UN-stable patients (3)

First-line →

if negative & patient stabilized →

Uncontrollable hemo instability/hemorrhage →

Answer 9

First-line: EGD
(unless hematochezia & low suspicion: → NG aspirate; NGA positive/inconclusive → EGD)

EGD negative & patient stabilized → Colonoscopy

Uncontrollable hemodynamic instability/hemorrhage → Angiography → Angioembolization or Surgery

Question 10

Imaging for suspected LGIB in hemodynamically
UN-stable patients

First-line →

Uncontrollable HD-instability/hemorrhage →

Answer 10

First-line: Colonoscopy

HDI: Angiography → Angioembolization or Surgery

Question 11

These 2 imaging procedures allow for bleeding source identification

Answer 11

Upper endoscopy
Colonoscopy

Question 12

Risk factors for upper GI bleeds:
1. H/o of UGIB
2. <50 y.o
3. History of __
4. ____ (organ system)
5. ↑ __ ratio

Answer 12

3. PUD (or risk for PUD)
4. Hepatic cirrhosis, portal hypertension
5. BUN/Cr (> 30:1)

Question 13

Risk factors for Lower GI bleeds:

1. H/o LGIB
2. colonic angiodysplasia (women)
3. _____
4. recent [procedure]
5. ____ cancer

Answer 13

3. diverticulosis
4. recent polypectomy
5. colorectal cancer

Question 14

Management of GI bleeding with hemodynamic instability:

*use in pts with re-bleeding
or
ongoing bleeding despite endoscopic hemostasis
(ex: cautery/clips/Epi)

Answer 14

Angiography/Angioembolization
(Interventional radiology)

• can also give vasopressin or Octreotide

Question 15

What is used as an antidote/reversal to warfarin?

Answer 15

prothrombin complex concentrate (PCC)