Week 10 Clinical Examination GI Bleed

Question 1

Most common GI bleed

Answer 1

Upper GI (75-80%)

More likely to have hemodynamics instability then lower GI (since more BS to UGI)
More in men

Question 2

Lower GI bleed facts

Answer 2

Older
Not usually hospitalized pt
Not as much hemodynamics instability

Question 3

Hematemesis bright red

Answer 3

Esophageal varacies or ulcer eroded into BV

Question 4

Hematemesis and coffee ground

Answer 4

PUD

Question 5

Melena

Answer 5

• usually secondary to UGIB

- can be LGIB (jejunum, cecum, right colon (AC))

Question 6

Hematochezia bright red

Answer 6

Bright red BRBPR
= Left colon bleed
= LGIB (unless massive GIB)

Question 7

Hematochezia dark maroon

Answer 7

RIGTH colon, jejunum, ileum

LGIB (unless massive upper)

Question 8

Most common UGIB in order

Answer 8

1. PUD *
2. Varices *
3. Mallory weis *
4. Erosion*
5. AV malfunction
6. Malignancy
7. Dieulafoy lesions

Question 9

Most common LGIBs in order

Answer 9

1. Diverticulosis
2. Anorectal disease (hemorrhoids, anal fissure)
3. Colitis (Ischemic, IBD, Infectious)
4. Colon cancer
5. AV ,angiodysplasia

Question 10

1 feature of having blood in GI

Answer 10

More pooping, blood can act like a laxative

Question 11

PAIN
UGIB
LGIB

Answer 11

1. UGIB : diffuse, epigastric, upper abd

2. LGIB : diffuse and lower abd

Question 12

2 questions to ask for just UGIB

Answer 12

Liver disease ? (Alcohol, hepatitis, cirrhosis)

H-pylori infection? (gastritis, PUD)

Question 13

Question to ask for LGIB only

Answer 13

IBD?

Diverticular disease?

Question 14

LABS in GI bleed pay attention to what

Answer 14

• elevated BUN
• bicarb : low then that means possible metabolic acidosis
• INR/PT/PTT
• cross match PRBCs (esp sick, shock pts)——> if severe pt do lactic acid and ABG

Question 15

TX for all GIBs

Answer 15

1. Is pt stable to no identification
2. IV : 2 18 gauge or larger, blood
3. Fluid bonus (Saline)
4. Blood transfusion if needed
5. Endoscopy and colonoscopy

Question 16

UBGI bleeds TX specific

Answer 16

1. PPI if PUD (Protonix)
2. Octreotide if Variceal bleed (somatostatin, not has good)
3. ABs of variceal bleed

Question 17

1 unit blood PRBC raise Hb by and hct by

Answer 17

1g/dL and hct by 3%

Question 18

FFP

Answer 18

Fresh Frozen Plasma (has all the coagulation factors so can be given when pt is on Coumadin or anti-coag and is bleeding)
= also called cryoprecipitate

Question 19

Platelets given when

Answer 19

Active Acute GI bleed and Plt < 50,000

= not needed for pt with anti-plt medications (NSAIDS for example)

Question 20

6 units of pots increase count by

Answer 20

Increase plt count by 50,000

Question 21

Transfusion of blood rule with HbB

Answer 21

1. Hb lower then 7g/dL
2. 8-10 : only is sx anemia , ongoing bleed, pt with comorbitity like CVD, coronary a D that worsens with anemia
3. Hb over 10 : never only special cases

Question 22

Isotonic crystal loud solution

Answer 22

IV fluid Hypotension from dehydration, D, blood loss

1. NS (normal saline ) : Na+, Cl-, water
2. Ringers Lactate : lactate, NA+, Cl-, Ca+ little, K+ little

Question 23

Endoscopy TX with injection

Answer 23

1. Vasoconstriction (epinephrine), saline, tissue adhesive, sclerosants
2. Submucosal cushion of fluid made = tamponade site and can also cause vasoconstriction
   (Ulcer)

Question 24

Endoscopy and thermal TX

Answer 24

Cauterize BV closed with electrocautery or laser (ulcer)

Question 25

Endoscopy TX with mechanical TX

Answer 25

1. Hemoclips or rubber bands

2. Closed and tamponade vessel

Question 26

Patient who is sent to a medial floor is watch for how long

Answer 26

72hrs for no further bleeding,

May finish blood transfusion there