GI Bleed (Exam 2)

Question 1

Patient presentation of a GI bleed varies by

Answer 1

site of bleeding within GI tract
rate of blood loss

Question 2

Upper GI bleed

Answer 2

bleeding proximal to ligament of treitz
esophagus, stomach, proximal duodenum

Question 3

Lower GI bleed

Answer 3

bleeding distal to ligament of treitz
small intestine, large intestine, anus

Question 4

Ligament of treitz

Answer 4

smooth muscle connecting diaphragm to duodenum

Question 5

what is the most common cause of a GI bleed?

Answer 5

peptic ulcer disease

Question 6

non-variceal (acid related) etiology of UGIB

Answer 6

PUD
SRMD

Question 7

variceal etiology of UGIB

Answer 7

portal hypertension in liver disease

Question 8

etiology of LGIB

Answer 8

IBD
colon cancer
diverticulitis
hemorrhoids
infectious disease

Question 9

treatment of GI bleed is geared towards

Answer 9

underlying cause

Question 10

patient presentation in GI bleed

Answer 10

blood in stool
bloody diarrhea
vomiting blood
nausea
abdominal pain
lightheadedness/dizziness, syncope, angina or dyspnea

Question 11

hematemesis

Answer 11

vomiting up blood
upper GI bleed

Question 12

melena

Answer 12

dark, tarry stools
upper GI bleed

Question 13

hematochezia

Answer 13

passage of bright red blood in stool
lower GI or upper GI bleed

Question 14

hematochezia can indicate upper GI bleed in cases of

Answer 14

quick bleeding

Question 15

treatment goals of GI bleed

Answer 15

identify and treat/remove source of bleed
achieve hemostasis and prevent rebleed
maintain hemodynamic stability
prevent complications

Question 16

what type of IV fluids are recommended if a patient is hypotensive

Answer 16

crystalloids (0.9% NaCl, lactated ringers)

Question 17

when is intubation recommended during a GI bleed?

Answer 17

severe ongoing hematemesis
altered mental status

Question 18

blood transfusion follows a

Answer 18

restrictive transfusion policy

Question 19

give a blood transfusion when Hgb is less than

Answer 19

7 g/dl

Question 20

1 package unit of RBC results in

Answer 20

Hgb increased by 1 g/dl
Hct increase of 3-4%

Question 21

when considering blood transfusion, consider

Answer 21

rate of blood loss
predicted drop in blood loss
clinical status

Question 22

you don’t need to wait to transfuse if

Answer 22

rapid blood loss

Question 23

preferred scoring tool for risk of rebleed

Answer 23

Glasgow Blatchford score (GBS)

Question 24

score of GBS ranges from

Answer 24

0-23

Question 25

low risk score for GBS high risk score for GBS

Answer 25

low - 0-1 high - score above 1

Question 26

GBS score for outpatient management

Answer 26

0-1

Question 27

endoscopy

Answer 27

visualization of GI tract with endoscope

Question 28

test of choice to evaluate UGIB

Answer 28

esophagogastroduodenoscopy (EGD)

Question 29

test of choice to evaluate LGIB why?

Answer 29

colonoscopy it evaluates the entire colon and rectum

Question 30

perform endoscopy within ___________ of admission for UGIB

Answer 30

24 hours

Question 31

do not delay endoscopy in patients on

Answer 31

anticoagulants

Question 32

what is suggested before endoscopy in UGIB and why

Answer 32

erythromycin transfusion enables better visualization

Question 33

high risk features

Answer 33

active bleeding or visible vessel

Question 34

intermediate risk features

Answer 34

adherent clot

Question 35

low risk features

Answer 35

flat pigmented spot or clean base

Question 36

high risk therapy

Answer 36

endoscopic therapy and high dose PPI

Question 37

intermediate risk therapy

Answer 37

yes/no endoscopic therapy and high dose PPI

Question 38

low risk therapy

Answer 38

no endoscopic therapy and standard PPI therapy

Question 39

what is the treatment of choice in non-variceal UGIB

Answer 39

PPIs

Question 40

high dose PPI therapy days 1-3

Answer 40

continuous therapy: 80 mg IV bolus then 8 mg/hr continuous infusion intermittent therapy: oral/IV 80mg bolus then 40mg BID-QID IV or PO

Question 41

High dose PPI therapy days 4-14

Answer 41

twice daily PO PPI

Question 42

high dose PPI therapy days 15+

Answer 42

once daily PO PPI

Question 43

standard PPI therapy

Answer 43

give an oral PPI once daily

Question 44

Intravenous PPIs

Answer 44

pantoprazole esomeprazole

Question 45

patient should be discharged with

Answer 45

once daily oral PPI

Question 46

stop medications that may have caused bleed until

Answer 46

benefit outweighs risk

Question 47

examples of medications that should be stopped

Answer 47

NSAIDs antiplatelets anticoagulants aspirin - primary CVD prevention

Question 48

should aspirin be stopped if a patient with a GI bleed takes it for secondary CV prevention? why?

Answer 48

no no significance in difference of bleeding or mortality

Question 49

when changing NSAIDs,

Answer 49

if needed COX2 inhibitor or other class drug and PPI

Question 50

when changing anti platelet therapy

Answer 50

clopidogrel, prasurgel, ticagrelor, aspirin and PPI

Question 51

when changing anticoagulant therapy

Answer 51

warfarin, apixaban, rivaroxoaban, dabigatran and PPI

Question 52

which PPIs does clopidogrel interact strongly with? weakly?

Answer 52

esomeprazole and omeprazole pantoprazole and rabeprazole

Question 53

PPIs inhibit ______________ which blocks ____________

Answer 53

CYP2C19 clopidogrels effects

Question 54

which PPIs would you want to use if the patient is on clopidogrel

Answer 54

consider pantoprazole or rabeprazole

Question 55

Stress ulcer prophylaxis should be given to

Answer 55

high risk ICU patients only STOP WHEN NO LONGER HIGH RISK!!