approach to GI bleed.

Question 1

What is the order of the approach to a patient with a severe bleed? 4 steps

Answer 1

1-ascertain bleeding has occurred
2-estimate rate/rapidity of bleed
3-stabilize patient
4-Investigate source

Question 2

When should you suspect aorto-enteric fistula?

Answer 2

• in someone who has had a surgical repair of their aorta (can happen years after surgery)
• gas in aorta or contrast in the bowel are red flags on imaging
• it is a surgical emergency

Question 3

if you suspect aorto-enteric fistula, what is the next step?

Answer 3

do a CT scan.

Question 4

Who gets Meckels diverticulum?

Answer 4

mostly kids.

it is always in the distal ileum and is resected if found. common anomaly of GI tract

Question 5

Small child with hematochezia. You suspect Meckel Diverticulum. What is the next step?

Answer 5

-get a “meckel scan” - tracers w/ affinity for gastric mucosa.

Question 6

iron deficiency anemia labs

Answer 6

• low ferritin
• low ferritin saturation
• normocytic or microcytic

Question 7

blood clots in stool tend to be present in upper or lower GI bleeds?

Answer 7

lower GI bleed.

Question 8

upper GI bleed with decompensated cirrhosis. Diagnosis?

Answer 8

think about varices.

Question 9

3 causes of Lower GI massive bleeds.

Answer 9

• diverticular bleed (vasa recta arteries)
• ischemia
• AVMs (arteriovenous malformations?)

Question 10

3 causes of lower GI non-massive bleeds.

Answer 10

• IBD
• colon cancer
• hemorrhoids (most common)

Question 11

varices and aortoenteric fistula commonly present as (upper/lower) GI bleeds.

Answer 11

upper

Question 12

what’s the difference between occult and obscure GI bleeds?

Answer 12

occult = not visible. detected by fecal occult blood test or iron deficiency

obscure = occult bleeding that persists or recurs after negative endoscopies. Approach is to do another endoscopy, then focus on the small bowel.