Upper/Lower GI Bleeding

Question 1

what constitutes a upper GI bleed

Answer 1

proximal to ligament of Trietz

Question 2

what constitutes a lwoer GI bleed

Answer 2

distal to ligament of Trietz

Question 3

what is hematemesis and its source

Answer 3

vomiting blood; upper GI bleed

Question 4

what is melena and its source

Answer 4

black, tarry, foul smelling stool; upper GI bleed or slow lower GI bleed

Question 5

what is hematochezia and its source

Answer 5

bright red or maroon-colored bloody stool; lower GI bleed or fast upper GI bleed

Question 6

source of blood-streak

Answer 6

lower GI bleed

Question 7

occult blood in stool

Answer 7

higher or lower GI bleed

Question 8

what is overt bleeding

Answer 8

visible blood (e.g., hematemesis, melena, hematochezia)

Question 9

what is occult bleeding

Answer 9

hidden bleeding

Question 10

what is obscure bleeding

Answer 10

bleeding from an undetermined source even after EGD and colonoscopy

Question 11

what lab is performed serially

Answer 11

H&H (hemoglobin and hematocrit)

Question 12

signs and symptoms of hemorrhagic shock

Answer 12

systolic BP < 100 mmHg, pulse > 100 (tachycardia), cool clammy skin

Question 13

risk factors for morbidity/moratlity in acute GI hemorrhage

Answer 13

age > 60
comorbid disease (renal failure, liver disease, cardiac disease, respiratory insufficiency)
magnitude of hemorrhage
persistent or recurrent hemorrhage
inpatient at time of bed
severe coagulopathy
need for surgery

Question 14

red flags of GI bleeding

Answer 14

onset > 50 years
rectal bleeding or melena
nocturnal pain
nocturnal diarrhea
progressive abdominal pain
unexplained weight loss, fever, other systemic symptoms
family hx of IBD
family hx of colorectal cancer
lab abnormalities (iron deficiency anemia, elevated CRP/ESR, elevated fecal calprotectin, positive hemoccult)

Question 15

tagged RBC scan can only detect ___

Answer 15

activ e bleeding

Question 16

causes of upper GI bleed

Answer 16

portal hypertension, peptic ulcer disease, retching (Mallory-Weiss tears, Boerhaave syndrome), tumors, esophagitis/gastritis, Dieulafoy lesion, Cameron lesions, etc.

Question 17

most common cause of upper GI bleed

Answer 17

peptic ulcer disease

Question 18

what is peptic ulcer disease

Answer 18

duodenal or gastric ulcers

Question 19

four major risk factors for peptic ulcer disease

Answer 19

H. pylori infection, use of NSAIDs, physiologic stress, excess HCl

Question 20

other causes of peptic ulcer disease

Answer 20

Cushing ulcers, Curling ulcers, Zollinger-Ellison syndrome

Question 21

clinical presentation of peptic ulcer disease

Answer 21

epigastric tenderness, pain after eating (gastric: immediate pain; duodenal: pain in 2-3 hours), pain relieved with fasting

Question 22

medications used for peptic ulcer disease

Answer 22

PPIs, H2 blockers, sucralfate

Question 23

what is a Dieulafoy lesion

Answer 23

large submucosal artery protruding through mucosa

Question 24

clinical presentation of Dieulafoy lesion

Answer 24

sudden onset of massive, painless hematemesis/melena

Question 25

what are Cameron lesions

Answer 25

linear erosion or ulceration in proximal stomach due to mechanical trauma and local ischmia

Question 26

causes of lower GI bleed

Answer 26

diverticulosis, andiodysplasia, colitis (infectious, ischemic, radiation), IBD, colon polyps, colon carcinoma, etc.

Question 27

acute versus chronic lower GI bleeding

Answer 27

acute - less than 3 days - may or may not be hemodynamically unstable - may or may not need blood transfusion chronic - passage of blood over several days - intermittent or slow loss - iron deficiency anemia - hemoccult positive stool

Question 28

what is angiodysplasia

Answer 28

abnormal, tortuous, dilated small blood vessel in the mucosa and submucosa (venous source)

Question 29

common clinical presentation of colitis

Answer 29

hematochezia, abdominal pain, fever, dehydration

Question 30

most common causes of infectious colitis

Answer 30

Clostridiodes difficile, CMV

Question 31

common sites of ischemic colitis

Answer 31

splenic flexure, recrtosigmoid junction

Question 32

clinical findings for obscure occult bleeding

Answer 32

iron deficiency anemia, hemoccult positive stool

Question 33

procedure of choice for obscure bleeding

Answer 33

video capsule endoscopy (PillCam)