GI bleeds

Question 1

Upper GI anatomical location

Answer 1

Proximal to ligament of Treitz (separates dudoenum/ jejenum)*I think

Question 2

Common causes of UGI bleed

Answer 2

Peptic ulcer disease (includes gastric, duodenal, esophageal, stomal)
Erosive gastritis and espohagitis
AV malformation
Aortoenteric fistula secondary to preexisting aortic graft
HIV, Candida, herpes, cytomegalovirus
Varices
Mallory-weiss
Dielafoy lesions
ETOH, infection, toxic ingestion, radiations, stress from severe illness (sepsis, trauma, resp failure)

Question 3

Causes of peptic ulcers

Answer 3

ASA, NSAIDS, smoking, H. pylori

Question 4

Esophageal and gastric varices

Answer 4

From portal vein HTN

Question 5

Mallory-Weiss syndrome

Answer 5

Bleeding secondary to longitudinal mucosal tear at gastroesophageal junction.
Classic presentation is repeat vomiting followed by hematemesis. DKA, binge ETOH, chemo.

Question 6

Dieulafoy lesions

Answer 6

Arteries of GI tract that protrude through submucosa. ~90% are found within 6cm of gastroesophageal junction.
GI bleeds without NSAID or ETOH hx

Question 7

Upper GI questions

Answer 7

Coffee ground, hematemsis, melena, <50 (>50 more likely lower GI) HX of ETOH, nsaids, peptic ulcers, diabetes, aortic graft, glucorticoids, anticoagulants.
Bismuth, iron mimic melena
Red dye, beets can mimic hematochezia
Bright red or maroon rectal bleeding originates from UGI 14% of time

Question 8

Vitals of GI bleed (mostly obvious)

Answer 8

Tachy, hypotensive, angina, syncope, weakness, confusion, cardiac arrest, decreased PP. Paradoxical bradycardia (beta blockers mask tachy compensation)

Question 9

Suggestions of liver disease

Answer 9

Spider angiomas, palmar erythema, jaundice, gynecomastia

Question 10

Underlying coagulopathy signs

Answer 10

Petechiae and purpura

Question 11

LGI anatomy

Answer 11

Distal to ligament of treitz

Question 12

Most common causes of LGI bleed

Answer 12

Blood most commonly found from UGI, if it is LGI then diverticular disease, colitis, adenomatous polyps, malignancies

Question 13

Patho of LGI

Answer 13

Hematochezia is UGI 10% of the time.

Melena Usually from UGI, but can be from LGI if bleed is slow

Question 14

Diverticulosis bleeding

Answer 14

Usually painless, from erosion into penetrating artery of diverticulum
90% resolve spontaneously

Question 15

Physical exam

Answer 15

Look for tenderness, organomegaly, masses, ascites.
No tenderness suggestions vasculature disorder like diverticulosis or angiodysplasia
Inflammatory bowel associated with tenderness

Question 16

BUN

Answer 16

Bleeding in GI that can be digested will elevate BUN

Question 17

ECG

Answer 17

ECG pts if you think ischemia is progressed