IM Essentials: Ch. 27 - Approach to Gastrointestinal Bleeding

Question 1

List the common causes of UGIB.

Answer 1

• Epistaxis
• Varices
• Mallory-Weiss tears
• Malignancy (esophageal or gastric)
• PUD most common
• Vascular malformation (Dieulafoy, AVM, angiectasias)

Question 2

List the common causes of LGIB.

Answer 2

• Diverticuli
• Malignancy (colorectal)
• Vascular malformations (AVM, angiectasias)
• Ischemic colitis
• Ulcerative colitis
• Inflammatory infectious diarrhea
• Hemorrhoids
• Anal fissures
• UGIB

Question 3

Differentiate ischemic colitis from mesenteric ischemia.

Answer 3

• MI: clot with sudden emboli to the mesenteric vasculature

* IC: atherosclerosis of the mesenteric vessels

Question 4

Resting tachycardia indicates how much blood loss?

Answer 4

15% to 30%

Question 5

Hypotension indicates how much blood loss?

Answer 5

30%

Question 6

Why is the initial hematocrit a poor indicator of blood loss in a GIB?

Answer 6

Volume is lost with RBCs, so the Hct can remain stable for the first 48 hours after GIB starts.

Question 7

What should you do in the initial workup of GIB?

Answer 7

• Two large IVs with IV bolus
• Type and cross
• IV PPI
• IV octreotide
• Page GI for endoscopy
• Vitals frequently
• Orthostatics

Secondarily:

• Coags
• BUN
• LFTs (for signs of cirrhosis)

Question 8

____________ is better at identifying the exact location of the bleed (once endoscopy fails).

Answer 8

Tagged RBC scans