GI Bleed

Question 1

common cause of gastric and/or duodenal ulcers

Answer 1

NSAIDs

stress (ICU)

Question 2

common cause of esophagogastric varices

Answer 2

cirrhosis

Question 3

common cause of severe or erosive esophagitis, gastritis, duodenitis

Answer 3

candida

ETOH

Question 4

common cause of portal hypertensive gastropathy

Answer 4

cirrhosis

Question 5

common cause of angiodyplasia

Answer 5

sequlea of other diseases (renal, cardiac, hepatic)

Question 6

common cause of mass lesions

Answer 6

polyps

cancer

Question 7

common cause of Mallory-Weiss syndorme

Answer 7

repetitive retching

Question 8

what percentage of patients with a GI bleed have no lesion identified?

Answer 8

10-15%

Question 9

clinical manifestations of a GI bleed

Answer 9

belly pain

hematemesis

melena

hematochezia

Question 10

what should we think with severe belly pain with involuntary guarding or rebound tenderness?

Answer 10

consider perforation

Question 11

what should we think with frank blood in vomit?

Answer 11

vigorous active bleed

Question 12

what should we think with coffee ground apperance in vomit?

Answer 12

slower, more limited bleeding

Question 13

is melena specific or nonspecific?

Answer 13

nonspecific

Question 14

when hematochezia is accompanied by hypotension (+/- signs of UGI bleed) it indicates what?

Answer 14

MASSIVE upper bleed

Question 15

orthostatic hypotension indicates ____ % total volume losss

Answer 15

15%

Question 16

supine hypotension indicates ____ % total volume loss

Answer 16

40%

Question 17

normal volumes of blood for:

males?

females?

Answer 17

male- 5.6L

female- 4.5L

Question 18

what is the maximum survivable blood loss?

Answer 18

about 40%

Question 19

testing everybody gets with a GI bleed

Answer 19

CBC - H&H, platelets

CMP- BUN (upper bleed), platelets (severe thrombocytopenia)

coagulation panel (anticoagulation)

type & cross- anticipate need for transfusion

Question 20

how often should we repeat an H&H on a patient with a GI bleed?

Answer 20

every 4-6 hours

Question 21

what makes a GI bleed non-urgent?

Answer 21

report or witnessed GI blood loss + normal vitals +/- tachycardia

Question 22

management for non-urgent GI bleed

Answer 22

GI consult

IV PPI, may transfuse

upper endoscopy today or sometime tomorrow

Question 23

what makes a GI bleed an emergency?

Answer 23

hypotension (of any kind) + frank blood (witnessed or reported)

Question 24

management for an emergent GI bleed

Answer 24

cardiac monitoring & frequent BP vhecks, O2

2 large bore IV sites, bolus IVF (at least 500cc), prepare to transfuse

IV PPI, IV Octreotide, IV reversal agent (if anticoagulated)

call GI for urgent endoscopy, call surgery & intensivist

Question 25

what is considered a significant drop in H&H in a GI bleed patient?

Answer 25

1 gram drop \*caution- hemodilution can throw you off\*

Question 26

blood digestion and reabsorption can _______ serum BUN

Answer 26

increase

Question 27

what BUN to Creatinine Ration indicates an UPPER GI bleed?

Answer 27

\> 20 : 1

Question 28

what are some causes of lower GI bleeds

Answer 28

hemorrhoids diverticular disease colitis colon cancer

Question 29

what do we do if we suspect a lower GI bleed?

Answer 29

first we want to rule out an upper bleed then proceed wtih colonoscopy

Question 30

what do we do if for our anticoagulated patient (on Coumadin) presenting with a GI bleed? non-urgent reversal? emergent reversal?

Answer 30

stop the medication call the Pharm D reverse the effects- INR \> 1.5, vitamin K IV or PO or non-urgent reversal Kcentra plus IV vitamin K for emergency reversal

Question 31

what do we do if for our anticoagulated patient (on direct oral anticoagulants) presenting with a GI bleed?

Answer 31

call the pharm D this is new & changed every day