Gastro-Intestinal Bleeding Overview

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Questions and Answers

What is defined as the passage of soft, tarry, and offensive stools?

Diverticulosis

Hematemesis

Melena (correct)

Hematochezia

Which condition is often associated with painless lower GI bleeding?

Diverticulosis (correct)

Hematemesis

Gastric cancer

Inflammatory bowel disease

Which of the following is a common cause of upper GI bleeding related to excessive vomiting?

Arteriovenous malformations

Esophageal ulcer

Gastritis (correct)

Diverticulosis

Which of the following can produce black stools but yield negative stool guaiac?

Bismuth subsalicylate Signup and view all the answers

What is the significance of only needing 50 ml of GI blood loss per day?

It is the threshold to cause melena. Signup and view all the answers

Which of the following is a risk factor for aortic grafts leading to bleeding?

Entero-aortic fistula Signup and view all the answers

Which condition is NOT commonly associated with upper GI bleeding?

Radiation proctitis Signup and view all the answers

Which of the following is a potential cause of both upper and lower GI bleeding?

Inflammatory bowel disease Signup and view all the answers

What is the primary role of urgent upper endoscopy in the management of upper GI bleeding?

To assess the source of bleeding and allow for hemostasis Signup and view all the answers

What is a key indication for performing a technetium-99m labeled red blood cell scan?

In patients with ongoing significant GI bleeding without an obvious source Signup and view all the answers

What amount of bleeding must be present for a technetium-99m labeled red blood cell scan to be useful?

0.05-0.1 ml/min Signup and view all the answers

In which scenario is capsule endoscopy indicated?

For chronic GI bleeding with negative colonoscopy and upper endoscopy Signup and view all the answers

What is the critical amount of bleeding required for a visceral angiogram to be considered useful?

0.5-1.0 ml/min Signup and view all the answers

Which factor would make an upper GI source of bleeding less likely?

Regular use of PPI Signup and view all the answers

What initial management step is crucial in a patient with GI bleeding?

Assessing hemodynamic stability Signup and view all the answers

Which diagnostic test is NOT typically included in the laboratory evaluation for GI bleeding?

Chest and abdominal radiographs Signup and view all the answers

What is an important aspect of patient history for assessing GI bleeding?

Number of recent bleeding episodes Signup and view all the answers

Which vital sign assessment is crucial in a patient with potential GI bleeding?

Blood pressure Signup and view all the answers

What should be confirmed by placing a nasogastric tube in a GI bleeding patient?

UGI source of bleeding Signup and view all the answers

What is the role of IV acid suppression therapy in GI bleeding management?

To decrease the risk of acute rebleed Signup and view all the answers

Which condition increases the probability of bleeding varices?

Cirrhosis Signup and view all the answers

What should be administered if a patient's PT or PTT is abnormal?

Vitamin K Signup and view all the answers

When is a nasogastric tube expected to show negative aspirate despite upper GI bleeding?

When the bleeding is transient Signup and view all the answers

What is the minimum platelet count that may necessitate a platelet transfusion in a patient with active bleeding?

< 50,000/ µl Signup and view all the answers

What hemoglobin level indicates the need to maintain a transfusion in patients with coronary artery disease?

<blockquote> 10 mg/dl </blockquote> Signup and view all the answers

What is the expected increase in hemoglobin level after transfusion of one unit of blood?

1 g/dl Signup and view all the answers

What condition may warrant keeping a nasogastric tube in place?

Active bleeding is evident Signup and view all the answers

Which of the following is a factor that suggests inpatient management due to high risk of intervention?

Ongoing symptoms of bleeding Signup and view all the answers

What is an appropriate risk factor indicating low risk for requiring transfusion?

Hemoglobin levels > 14 (Men) Signup and view all the answers

Study Notes

Classification of Gastrointestinal Bleeding

Upper GI Bleeding: Occurs above the ligament of Treitz.
Lower GI Bleeding: Occurs below the ligament of Treitz.

Definitions of Key Terms

Hematemesis: Vomiting blood, often resembling "coffee grounds" due to stomach acid degradation.
Hematochezia: Red or maroon blood in stool, associated with lower GI bleeds and rapid upper GI bleeds.
Melena: Soft, tarry, and foul-smelling stools indicating upper GI bleeding, requiring only 50 ml of daily blood loss for occurrence.

Differential Diagnosis of Melena

Conditions producing black stools without blood include:
- Bismuth subsalicylate
- Iron supplements
- Spinach
- Charcoal

Causes of Upper GI Bleeding

Common Sources:
- Gastritis: Often related to NSAIDs, alcohol, or stress.
- Ulcers: Typically caused by H. pylori or NSAIDs.
- Mallory-Weiss Tear: Due to excessive vomiting.
- Gastric Cancer: Can present as a source of bleeding.

Causes of Lower GI Bleeding

Common Sources:
- Diverticulosis: Most frequent cause, usually painless.
- Inflammatory Bowel Disease: Often accompanied by diarrhea.
- Neoplasms: Can be benign or malignant, potentially cause chronic bleeding.

Patient Approach

History Taking

Focus on episodes of bleeding, medication use (NSAIDs, anticoagulants), alcohol abuse, and prior surgeries.

Physical Examination

Assess vital signs, complexion, abdominal exam, rectal examination for masses, and neurological signs.

Diagnostic Tests

Laboratory:
- Blood typing and cross-matching
- Complete blood count
- Electrolyte levels
- Liver function tests
Radiological:
- Chest and abdominal radiographs
- Electrocardiography

General Management Guidelines

Initiate care promptly before determining the bleeding cause.
Evaluate hemodynamic stability through an ABC approach (airway, breathing, circulation).
Fluid resuscitation is crucial; blood transfusion may be indicated if hemoglobin drops significantly.

Use of Nasogastric Tube (NGT)

NGT insertion helps ascertain if an upper GI bleed exists.
Negative aspirate does not rule out upper GI bleeding if the source is distal.

Risk Assessment and Management

Evaluate risk factors for inpatient vs. outpatient management.
ICU admission may be necessary for unstable patients or those with serious comorbid conditions.

Role of Endoscopy

Urgent upper endoscopy is essential for ongoing upper GI bleeding.
Colonoscopy indicated for suspected lower GI bleeding, especially if bleeding has ceased.

Advanced Diagnostic Methods

Technetium-99m Scan: Useful for localizing bleeding source when ongoing significant gastrointestinal bleeding is present.
Visceral Angiogram: Allows for diagnosis and therapeutic embolization if bleeding is detected.
Capsule Endoscopy: Used for chronic bleeding cases not explained by prior endoscopies.

Monitoring

Regularly check BUN/Creatinine ratio to assess kidney function and blood loss.

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Description

This quiz covers the essential concepts of gastro-intestinal bleeding, focusing on the classifications of upper and lower GI bleeding. It includes definitions of key terms such as hematemesis and hematochezia. Ideal for medical students and healthcare professionals looking to reinforce their understanding of this critical topic.