Upper GI Bleeding

Question 1

BUN to CR ratio suggestive of GI bleeding proximal to ligament of Treitz

Answer 1

30

Question 2

Forest Class IA Ulcer and rebleed risk

Answer 2

Active spurting, 55%

Question 3

Forest Class 1B Ulcer and Rebleed Risk?

Answer 3

Oozing, 55%

Question 4

Forest Class 2A Ulcer and Rebleed Risk

Answer 4

Visible vessel, 45%

Question 5

Forest Class 2B Ulcer and rebleed risk

Answer 5

Adherent clot, 25%

Question 6

Forest Class 2C ulcer and rebleed risk

Answer 6

Pigmented spot, 10%

Question 7

Forest Class 3 Ulcer and rebleed risk

Answer 7

Clean based, 5%

Question 8

How does PPI compare with H2 Blocker for UGIB post endoscopy?

Answer 8

Reduces rebleeding though does not change the risk of surgery or mortality

Question 9

Blue rubber bleb nevus syndrome

Answer 9

Congenital disease that causes venous blebs under skin and GI tract

Question 10

Most sensitive imaging modality for GI bleeding? How much blood loss can it detect?

Answer 10

Tagged RBC scan can detect 0.2cc/min. CTA can detect 0.3cc/min.

Question 11

Can epinephrine or saline be used alone to treat ulcers endoscopically?

Answer 11

No, worse outcomes compared to clips or bipolar alone