Who is MC affected by GI bleeds?
Males and elderly
What is MC - upper or lower GI bleed?
Upper
Where does an upper GI bleed originate?
Proximal to ligament of Treitz
Where does a lower GI bleed originate?
Inferior to ligament of Treitz
Coffee ground hematemesis is suggestive of what type of GI bleed?
Upper
Melena is suggestive of what type of GI bleed?
Upper
ETOH is suggestive of what type of GI bleed?
Upper
Hematochezia is suggestive of what type of GI bleed?
Lower
Labs for GI bleed work up
- Blood type and cross match (# of units)
- CBC (H/H, platelets)
- BUN
- Coag (PT/PTT), troponin, EKG
X-rays in evaluation of GI bleed
Limited value
CT in evaluation of GI bleed
- Poor localization of bleed site
- Barium limits subsequent endoscopy or angiography
- Useful if aortoenteric fistula suspected
Angiography in evaluation of GI bleed
- Requires brisk bleeding rate to be diagnostic
- Can allow for embolization or vasoconstrictive injection hemostasis
Scintigraphy in evaluation of GI bleed
- Nuclear scan
- More sensitive than angiography
Endoscopy/colonoscopy in evaluation of GI bleed
- Can be diagnostic and therapeutic if site is amenable to cautery or vasoconstrictive meds
- Limited visualization
Treatment of GI bleed
- ABCs, cardiac monitoring, O2
- IVF of at least 2L
- Blood transfusion if necessary
- NG tube and lavage maybe
- Pantoprazole
- Octreotide IV for varices or PUD
- GI consult, Blakemore tube
When would NG tube and lavage be helpful in GI bleeds?
- To determine origin of bleed
- May assist w/nausea
- Use w/caution in pts with known or suspected varices
What findings are predictive of poor outcome of GI bleed?
- Initial Hct under 30
- Initial SBP under 100
- Bright red blood in NG lavage
- Hx of cirrhosis or current ascites
- Hx of vomiting bright red blood
- Use of anticoags
