Upper GI Bleeds

Question 1

How do you first manage Upper GI Bleeds?

Answer 1

Initial Assessment and Resuscitation

Question 2

What is the Initial Assessment and Resuscitation for Upper GI bleeds?

Answer 2

Remember, ABCs
[Airway? CPR?] 
IV access.
[At least 2 large bore IVs]
Infusion.
[Crystalloid (NS), Blood products]

Question 3

What is the Secondary Assessment for upper GI bleeds?

Answer 3

Laboratory studies. 
Underlying patient conditions. 
[Sever cardiac disease, Liver disease, Coagulopathy]
Closely monitor vital signs.
Determine appropriate level of care.
[Hospital vs. home, ICU vs. floor]

Question 4

What should you do after secondary assessment for Upper GI bleeds?

Answer 4

Call in help.
[Gastroenterologist, Surgeon]
Appropriate care plan.
[Procedures, Medications, Monitoring, Follow up]

Question 5

What is the presentation for Esophageal Varices?

Answer 5

Dramatic bleeding, usually hematemesis

Question 6

What is the cause of Esophageal Varices?

Answer 6

Portal Hypertension

Question 7

What are Esophageal Varices associated with?

Answer 7

Liver disease/cirrhosis

Question 8

What is the treatment goal for Esophageal Varices?

Answer 8

Lower portal pressure

Question 9

What are the five treatments for esophageal varices and how do they work?

Answer 9

• Octreotide/Vasopressin (hospital)
• PPI (decreases stomach acid that can come up and irritate varices)
• Non-selective beta-blocker (outpatient)
• Variceal band ligation
• TIPS/Surgical Shunt - don’t ntk but it connects systemic and portal circulations - last ditch measure

Question 10

What are the top two risk factors for Peptic Ulcer Disease?

Answer 10

H. pylori (OR 4.05), NSAIDs (OR 2.99). H. pylori plus NSAIDs have a synergistic effect (OR 15.4)

Question 11

What are four tests used for diagnosis of H. pylori?

Answer 11

Breath test, Stool test, Serology and Biopsy

Question 12

What are two tests that should be done to see if H. pylori has been eradicated?

Answer 12

Breath or stool test only!