Chapter 39: Upper Gi Bleeding

Question 1

what is it

Answer 1

bleeding into the lumen of the proximal git ie proximal to the ligament of trietz

Question 2

what are the signs and symptoms

Answer 2

1. Hematemesis
2. melena
3. syncope
4. shock
5. fatigue
6. coffee-ground emesis
7. hematochezia
8. epigastric discomfort,
9. epigastric tenderness
10. signs of hypovolemia
11. guaiac-positive stools

Question 3

Why is it possible to have hematochezia?

Answer 3

Blood is a cathartic, and hematochezia usually indicates a vigorous rate of bleeding from the UGI source

Question 4

Are stools melenic or melanotic?

Answer 4

Melenic (melanotic is incorrect)

Question 5

What is the most common cause of significant UGI bleeding?

Answer 5

PUD—duodenal and gastric ulcers (50%)

Question 6

What is the common differential diagnosis of UGI bleeding?

Answer 6

1. Acute gastritis
2. Duodenal ulcer
3. Esophageal varices
4. Gastric ulcer
5. Esophageal
6. Mallory–Weiss tear

Question 7

What is the diagnostic test of choice with UGI bleeding?

Answer 7

EGD (>95% diagnosis rate)

Question 8

What are the treatment options with the endoscope during an EGD?

Answer 8

1. Coagulation
2. injection of epinephrine (for vasoconstriction)
3. injection ofsclerosing agents (varices)
4. variceal ligation (banding)

Question 9

Which lab tests should be performed?

Answer 9

1. Chem-7
2. bilirubin
3. LFTs
4. CBC
5. type and cross
6. PT/PTT
7. amylase

Question 10

Why is BUN elevated?

Answer 10

Because of absorption of blood by the GI tract

Question 11

What is the initial treatment?

Answer 11

1. IVFs (16 G or larger peripheral IVS × 2), Foley catheter (monitor fluid status)
2. NGT suction (determine rate and amount of blood)
3. Water lavage (use warm H2O—will remove clots)
   4. EGD: endoscopy (determine etiology/location of bleeding and possible treatment—coagulate bleeders)

Question 12

Why irrigate in an upper GI (UGI) bleed?

Answer 12

To remove the blood clot so you can see the mucosa

Question 13

What test may help identify the site of MASSIVE UGI bleeding when
EGD fails to diagnose cause and blood continues per NGT?

Answer 13

Selective mesenteric angiography

Question 14

What are the indications for surgical intervention in UGI bleeding?

Answer 14

1. Refractory or recurrent bleeding and site known
2. >3 unit PRBCs to stabilize or >6 unit PRBCs overall

Question 15

What percentage of patients require surgery?

Answer 15

≈10%

Question 16

What percentage of patients spontaneously stop bleeding?

Answer 16

≈80% to 85%

Question 17

What is the mortality of acute UGI bleeding?

Answer 17

Overall 10%, age 60 to 80 years 15%, age >80 years 25%

Question 18

What are the risk factors for death following UGI bleed?

Answer 18

1. Age >60 years
2. Shock
3. >5 units of PRBC transfusion
4. Concomitant health problems