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Flashcards in GI Bleed Deck (20):
1

What is more common UGIB or LGIB

UGIB

2

Causes UGIB

- Peptic Ulcer Disease- Gastric ulcers more likely to bleed >duodenal
- Esophageal varices
- Severe or erosive esophagitis
- Severe or erosive gastritis/duodenitis
- Mallory-Weiss Syndrome

3

Where does LGIB originate

colon, distal to the ligament of Treitz

4

Main cause LGIB

Diverticular bleed

5

BRB means

new blood

6

Coffee ground means

originate in stomach or upper GI and old blood

7

Melena means

passing of black tarry stool common of GI bleed

8

Hematochezia more common in

LGIB

9

Clinical Mallory- Weiss Tear- UGIB

emesis, retching, coughing prior to hematemesis

10

Clinical variceal hemorrhage- UGIB

Jaundice, weakness, fatigue, anorexia, abdominal distention

11

Clinical malignancy- UGIB

Dysphagia, early satiety, involuntary weight loss, cachexia

12

Sx prior to bleeding

o Painless – consider diverticular bleeding
o Change in bowel habits – consider malignancy
o Abdominal pain, diarrhea – consider colitis

13

Clinical LGIB

- Painless bleeding most common
- May sense abdominal fullness and urge to pass stool
- Hematochezia
- Maroon colored or mixed blood with stool
- Melena (rare, may occur with right sided bleeds)

14

Clinical GIB

- resting tachycardia, orthostatic hypotension (HR increase 20pts and systolic BP decrease 10-20mmHg)
- pale conjunctiva, pale oral mucosa, dry mucosa
- pale, grey, clammy, cool extremities
- Abdomen: normal ->distention->caput medusa->ascites - >tenderness->rebound
- Rectal: guaic + melena

15

Lab GIB

CBC with diff – assess for anemia
- Normal initially, therefore repeat q2-8 hours
- MCV normal
- Look at HgB and Hct
CMP and LFT
- BUN –to- creatinine ratio >20:1 if actively bleeding
Coags
- INR, PT, PTT (any can be elevated)
ECG
- Assess for demand ischemia (elderly, hx CAD, chest pain, dyspnea)
- Troponins may be positive but usually due to demand ischemia
Type and Cross because may need blood transfusion

16

UGIB gold standard

Endoscopy- Used to exclude, LGIB and unstable patients

17

LGIB gold standard

Colonoscopy

18

Tx UGIB

- Hospitalization
- Two large bore peripheral IV
- Type and cross for blood
- IVF resuscitation and/or blood transfusion and/or clotting factors (500mL or 2L given of IVF); give pRBC is Hgb less than 7; INR>1.5 FFP
- IV PPI BID* (Esomeprazole, pantoprazole)
- IV Octreotide* 50mcg IV bolus -> continuous infusion 50mcg/hr x3-5 days
- Reversal agents for anticoagulant or antiplatelet therapies +/-
- Prokinetic agents (e.g. erythromycin 3mg/kg IV) 30-90 minutes before endoscopic to aid in visualization
- Endoscopy (hemodynamically stable) +/- endoscopic therapy; Injection therapy (epinephrine), thermal coagulation, hemostatic clips, fibrin sealant, band 
ligation
- Rare intervention: angiography with transarterial embolization, surgical 
treatment (vagotomy, pyloroplasty, etc) – typically if failed endoscopy
Endotracheal intubation – massive bleeding

19

Tx esophageal varicies

- Prophylactic antibiotics – esophageal varices – broad spectrum
- Intrahepatic portosystemic shunt placement (TIPS)
- Balloon Tamponade – Blakemore tube (requires intubation)

20

Tx LGIB

- Hospitalization
- Two large bore peripheral IV or a central line
- Type and cross for blood
- IVF resuscitation and/or blood transfusion and/or clotting factors
- Reversal agents for anticoagulant or antiplatelet therapies +/-
- Colonoscopy with therapy
- CT angiography with sclerotherapy