GI Bleed Lecture

Question 1

Causes of gastric and/or duodenal ulcers

Answer 1

NSAIDs
Stress (ICU)

Question 2

Cause of esophagogastric varices?

Answer 2

Cirrhosis

Question 3

Causes of erosive esophagitis, gastritis, duodenitis

Answer 3

Candida
ETOH

Question 4

Cause of portal HTN gastropathy

Answer 4

Cirrhosis

Question 5

Angiodysplasia (aka vascular ectasia) is caused by…

Answer 5

sequela of other disease (renal, cardiac, hepatic)

Question 6

Mass lesions are caused by…

Answer 6

Polyps
Cancer

Question 7

Mallory-Weiss is caused by…

Answer 7

Repetitive retching

Question 8

what percentage of GI bleeds have no lesion identified

Answer 8

10-15%

Question 9

Stomach pain (severe with involuntary guarding or rebound tenderness)
Hematemsis
Melena
Hematochezia

Answer 9

Clinical presentation of GI bleed

Question 10

Frank blood hematemesis=

Answer 10

vigorous, active bleed

Question 11

Coffee ground hematemesis=

Answer 11

slower, limited bleeding

Question 12

Black tarry stools

Non specific, seen in various bleeds

can show up with as little as 50 cc of blood

Answer 12

Melena

Question 13

Melena can be seen with as little as ____ cc of blood

Answer 13

50

Question 14

Bright red to maroon

ususally seen in lower GI bleed

Answer 14

Hematochezia

Question 15

Hematochezia + hypotension (+/- signs of upper bleed) =?

Answer 15

MASSIVE UPPER GI BLEED!!

Question 16

>20:1 BUN to Creatinine ratio indicates…

Answer 16

upper GI bleed

Question 17

What is the order of severity for these:

A. tachycardic with normal BP
B. stable vitals
C. supine hypotension
D. orthostatic hypotension

Answer 17

Best to worst:

1. stable vitals
2. tachycardic with normal BP
3. orthostatic hypotension
4. supine hypotension

Question 18

Orthostatic hypotension indicates about a ___% total volume loss

Answer 18

15%

Question 19

Supine hypotension indicates about a ___% total volume loss

Answer 19

40%

Question 20

What is approx. the max survivable blood loss?

Answer 20

40%

(~40% total volume loss= supine hypotension)

Question 21

How often should you recheck H+H?

Answer 21

q4-6 hours

Question 22

What labs should you order for a GI bleed pt?

Answer 22

CBC
CMP
Coag panel
Type and cross

Question 23

Reported or witness GI blood loss
Normal vitals
+/- tachycardia

..urgent or non urgent?

Answer 23

Non urgent

GI consult, IV PPI, transfuse?, upper endoscopy later today or tomorrow

Question 24

Hypotension with frank blood (witnessed or reported)

emergent or non urgent?

Answer 24

EMERGENT!!!!

Question 25

Cardiac monitoring, frequent BP checks
Est 2 large bore IV sites
IVF (at least 500 cc wide open)
O2
Prepare to transfused, IV PPI
IV octreotide (if variceal bleed suspected)
IV reversal agents
Call GI for urgent endoscopy
Call gen surgery, call intensivist

Answer 25

actions to take in a GI bleed emergency

(ie hypotension with frank blood)

Question 26

Measure H+H over time (q4 hours is common)

a ___gram drop is significant!!

Answer 26

1 gram

(ie 10.0 to 8.9)

Question 27

Cirrhosis
Vigorous bleeding with high rebleed risk
tx= octreotide
Endoscopy

Transjugular Intrahepatic Portosystemic Shunt (TIPS)

Answer 27

Variceal bleed

Question 28

How do you reverse effects of anticoagulated pts in a non urgent GI bleed?

Answer 28

Vitamin K IV or PO

Question 29

How do you reverse effects of anticoagulated pts in a emergent GI bleed?

Answer 29

KCentra + IV Vit K

Question 30

Causes:
Hemorrhoids
Diverticular dz
Colitis
Colon cancer

*first R/O upper bleed, then process to colonscopy

Answer 30

Lower GI bleeds