UGIB

Question 1

Upper GI bleeding is any GI bleeding originating where?

Answer 1

proximal to the ligament of Treitz

Question 2

_______________which includes gastric, duodenal, esophageal, and stomal ulcers, is still considered the most common cause of upper GI bleeding

Answer 2

peptic ulcer disease

Question 3

_________________is the cause of upper GI bleeding in cirrhotics 59% of the time, followed by____________ in 16% of cases

Answer 3

Variceal bleeding

peptic ulcer disease

Question 4

_____________________is bleeding secondary to a longitudinal mucosal tear at the gastroesophageal junction

Answer 4

Mallory-Weiss syndrome

Question 5

Mallory-Weiss syndrome classic history is

Answer 5

repeated vomiting followed by bright red hematemesis

Question 6

True or false

Mallory-Weiss syndrome can be associated with alcoholic binge drinking, DKA, or chemotherapy administration. As well as Valsalva maneuver, such as from coughing or seizures

Answer 6

True

Question 7

These are arteries of the GI tract that protrude through the submucosa.

Answer 7

Dieulafoy lesions

Question 8

Dieulafoy lesions are most commonly found in the___________________ but may be found anywhere in the GI tract; 80% to 95% are found within __________________

Answer 8

lesser curvature of the stomach

6cm of the gastroesophageal junction

Question 9

Classically, this presents as a self-limited “herald” bleed with hematemesis or hematochezia, which precedes massive hem- orrhage and exsanguination.

Answer 9

An aortoenteric fistula secondary to a preexisting aortic graft

This is an unusual but important cause of bleed

Question 10

True or false

Bright red or maroon rectal bleeding unexpectedly originates from upper GI sources about 14% of the time

Answer 10

True

Question 11

is the most reliable way to diagnose upper GI bleeding in the ED

Answer 11

Visual inspection of the vomitus for a bloody, maroon, or coffee- ground appearance

Question 12

In patients with significant bleeding, the single most important laboratory test is _____________

Answer 12

obtain blood for type and cross-match

in case transfusion is needed

Question 13

A BUN:creatinine ratio of _______ suggests an upper GI source of bleeding

Answer 13

≥30

Question 14

Barium contrast studies are contraindicated because barium may

Answer 14

hinder subsequent endoscopy or angiography

Question 15

In cases where traditional endoscopy is unavailable or endoscopic visualization is unable to find the source, consider _______________ or ______________

Answer 15

tagged red-cell scintigraphy

visceral angiography

Question 16

True or false

tagged red-cell scintigraphy or visceral angiography, demonstrate the source ONLY in cases of active bleeding

Answer 16

True

Both help localize the source of bleeding to determine whether medical or surgical management is optimal

Question 17

What can cause false-negative results ?

Answer 17

Intermittent bleeding, pyloric spasm, or edema preventing reflux of duodenal blood

Question 18

Pre-endoscopic predictors of higher risk include:

Answer 18

advanced age
comorbidities
red hematemesis
hematochezia
red blood on nasogastric aspirate
hemodynamic instability
abnormal laboratory studies
prior variceal banding
clamping or cauterization of an ulcer bed
transjugular intrahepatic portosystemic shunt procedure

Question 19

A restrictive transfusion threshold using hemoglobin concentrations of__________ in most patients and __________ in older patients with comorbidities who are not tolerating the acute anemia is recommended.

Answer 19

<7 grams/dL

<9 grams/dL

Question 20

An INR______ is a significant predictor of mortality in patients with an upper GI bleed who are receiving anticoagulants.

Answer 20

≥1.5

Question 21

International consensus guidelines recommend reversal of coagulopathy for upper GI bleed patients who have an elevated INR or platelet counts ________

Answer 21

<50,000/μL

Question 22

Octreotide mechanism of action

Answer 22

Octreotide is a long-acting analogue of somatostatin that elicits several actions in patients with upper GI bleeding. It inhibits the secretion of gastric acid, reduces blood flow to the gastroduodenal mucosa, and causes splanchnic vasoconstriction

Question 23

Why do we give antibiotics in bleeding cirrhotic patients?

Answer 23

Patients with cirrhosis have an impaired immune system and have an increased risk of gut bacterial translocation during an acute bleeding episode. Prophylactic antibiotics (e.g., ciprofloxacin 400 milligrams IV or ceftriaxone 1 gram IV) reduce infectious complications, rebleeding, days of hospitalization, mortality from bacterial infections, and all-cause mortality

Question 24

What are examples of promotility agents? Function?

Answer 24

Erythromycin and metoclopramide are examples of promotility agents used to enhance endoscopic visualization. Consider administration if the patient is undergoing endoscopy in the ED and the patient is sus- pected to have large amounts of blood in the upper GI tract.

Question 25

What is the diagnostic study of choice in UGIB?

Answer 25

Upper GI endoscopy

Question 26

What is the timing of endoscopy?

Answer 26

Early endoscopy (within 6–24 hours of presentation for unstable patients if adequately resuscitated and 12–36 hours for stable patients45) is recommended for most patients