Upper GI Bleeds - Thackeray

Question 1

How do you identify upper GI bleeding?

Answer 1

• Overt = Signs of GI blood loss are visible
  
  • Hematochezia - Bright red blood per rectum
  • Melena - Black tarry stools
  • Hematemesis – Vomiting fresh blood or “coffee grounds”
  • Volume loss – shock, fainting, loss of consciousness
• Obscure = Signs of GI bleeding not seen directly
  
  • Iron deficiency anemia
  • Fatigue
  • Pale
  • Dyspnea
  • Angina

Question 2

What is the DDx for causes of upper intestinal bleeding?

Answer 2

• Varices
• Esophagitis
• Mallory Weiss tear
• Ulcers
• Tumors

Question 3

What are the common causes of peptic ulcer disease?

Answer 3

• H. Pylori (4.05x risk)***
• Non-steroidal anti-inflammatory drugs (NSAIDs) (2.99x risk)***
  
  • H.Pylori + NSAID = synergistic effect (15.4x risk)
• Drugs
• Zollinger-Ellison/Gastrinoma
• Crohn’s Disease
• Lymphoma

Question 4

How do you initially manage patients with upper GI bleeds?

Answer 4

• Initial Assessment and Resuscitation ***
  
  • –Remember ABC’s
    
    • Airway?
    • CPR?
  • –IV access
    
    • At least 2 large bore IVs
  • –Infusion
    
    • Crystalloid
    • Blood products

Question 5

What does the Secondary Assessment consist of when managing patient’s with upper GI bleeds?

Answer 5

• –Laboratory studies
• –Underlying patient conditions
  
  • Severe cardiac disease
  • Liver disease
  • Coagulopathy
• –Closely monitor vital signs
• –Determine appropriate level of care
  
  • Hospital vs home
  • ICU vs Floor

Question 6

What is the typical presentation, causes, associations, and treatments of Varices?

Answer 6

• Presentation: Dramatic bleeding, usually hematemesis
• Causes: Portal hypertension
• Associated with: Liver disease/cirrhosis
• Treatment:
  
  • Octreotide or Vasopressin
  • Proton Pump inhibitor
  • Non-selective Beta-blocker
  • Variceal band ligation
  • TIPS/Surgical shunt

Question 7

What are the two ways that you can test for the eradication of H. pylori?

Answer 7

Breath test or stool test (direct antigen) should be done

Question 8

What are the risk factors for Peptic Ulcer Disease?

Answer 8

• NSAID (ask about Aleve too)
• H. pylori
• Cigarette smoking
• Family history
• Physiologic stress (ventilation, etc.)
• No clear association with diet, psychologic factors, EtOH (except with NSAID), corticosteroids alone