S/Sx 3 = GI bleeds

Question 1

This structure widens the andle of the duodenojejunal flexure, allowing movement of intestinal contents

Answer 1

Ligament of Treitz

Question 2

Essentials of diagnosis of Acute upper GI bleed (proximal to lig of treitz)

Answer 2

Hematemesis
Varying hypovolemia
Maybe melana, if massive then hematochezia

Question 3

Describe some popular etiologies for acute upper GI bleeding

Answer 3

1. PUD 40%
2. Portal hypertension (varices) 10-20%
3. Mallory Weiss tear (GEJ)
4. Vascular anomalies 7%
5. Neoplasm 1%
6. Others - gastritis, esophagitis
   Booerhave

Question 4

Describe emergency care for acute upper GI bleed patient

Answer 4

1. Assess for and stabilize hypovolemia/shock

Unstable = <100 mmhg/ >100 pulse
IV, CBC/PTR/INR/CMP/Type and screen
Fluid replacement (2-4 PRBC)
NG tube

Then triage once stabilizes

Question 5

What patients would be admitted to the ICU with a Upper GI bleed? When would you do this?

Answer 5

Once patient is stabilized, we triage

If :

Age 60+
Comorbid illness
<100mmhg BP or >100 pulse
Bright red aspirate or rectal bleeding

Then….. –> ICU

Question 6

What upper GI patients get an EGD? Why do we do it?

Answer 6

**ALL patients with active upper GI blee w/in 24 HOURS.

ID bleed, determine risk or rebleed, Intervene

Question 7

What pharmacotherapy is involved with upper GI bleeds

Answer 7

IV or PO PPI. Lower risk of bleed from ulcer, esophagitis (erosive), and MW tear

Octreotide - reduce portal blood pressure

Question 8

What is the major presentation of an acute lower GI bleed?

Answer 8

Hematohezia with or without pain

Question 9

Most likely causes (3) of a lower GI bleed in pt under 50

Answer 9

Anorectal disease
Inflamm bowel disease
Infectious colitis

Question 10

Most likely causes (4) of lower GI blee in pt over 50

Answer 10

Diverticulosis
Malignancy
Angioectasias
Ischemic colitis

Question 11

Differentiate the sources of bleeding in lower GI based on Bright, maroon, and black color blood

Answer 11

Bright - left colonic
Maroon - SI or right colonic
Black - Upper GI

Question 12

Differentiate causes of lower GI bleed based on pain presentation

Answer 12

Painful defecation (rectal)- Ext hemorrhoids, anal fissure

ABD cramps/pain - IBD, Colitis

Painless - Internal hemorrhoids, Diverticular bleeding

Question 13

Differentiate causes of lower GI bleed based on volume

Answer 13

Large - diverticular

Small - IBD and Hemorrhoids

Question 14

How do we evaluate/work up a LGIB patient?

Answer 14

Lab - CBC and CMP (anemia = not good **neoplasm)

Diagnostic - **First exclude upper GI

Anoscopy/sigmoid/colonoscopy
Technetium scan/angiography
Capsule

Question 15

What are some treatment options for Acute lower GI bleed

Answer 15

Therapeutic colonoscopy - epi, cautery, clips
Intra arterial embolization
Surgery **** If pt needs 6+ units PRBC in 24hrs or 10 total.

Question 16

Obscure GI bleeding means what?

Answer 16

Bleed of unknown origin….. But usually small intestine

Question 17

An obscure-occult GI bleed can result in a loss of how much blood per day? How do we ID these?

Answer 17

100ml / day

FOBT
Fecal immunochemical test (Lower only)
Unexplained anemia on CBC

Question 18

If we have a positive fecal occult blood test, what should we also do?

Answer 18

Get a CBC to check for anemia (investigate neoplasm.

Search for source

+ anemia = Floss em (colonoscopy and egd)
0 anemia = colonoscopy