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- Upper gastrointestinal bleeding (UGIB) originates proximal to the ligament of Treitz, while lower gastrointestinal bleeding (LGIB) originates distal to this point. The first priority is ensuring the patient is hemodynamically stable.
- Common causes of LGIB include colon cancer, colitis, diverticulosis, angiodysplasia, and anorectal issues like hemorrhoids or anal fissures. Common causes of UGIB include peptic ulcer disease, varices, gastritis, erosive esophagitis or ulcers, and Mallory-Weiss tears.
- A history should inquire about symptoms of bleeding, changes to bowel movements, recent
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Summary Notes around GI Bleeds, formatted using the Markdown formatting standard.
- Upper gastrointestinal bleeding (UGIB) originates proximal to the ligament of Treitz, while lower gastrointestinal bleeding (LGIB) originates distal to this point. The first priority is ensuring the patient is hemodynamically stable.
- Common causes of LGIB include colon cancer, colitis, diverticulosis, angiodysplasia, and anorectal issues like hemorrhoids or anal fissures. Common causes of UGIB include peptic ulcer disease, varices, gastritis, erosive esophagitis or ulcers, and Mallory-Weiss tears.
- A history should inquire about symptoms of bleeding, changes to bowel movements, recent
- Upper gastrointestinal bleeding (UGIB) originates proximal to the ligament of Treitz, while lower gastrointestinal bleeding (LGIB) originates distal to this point. The first priority is ensuring the patient is hemodynamically stable.
- Common causes of LGIB include colon cancer, colitis, diverticulosis, angiodysplasia, and anorectal issues like hemorrhoids or anal fissures. Common causes of UGIB include peptic ulcer disease, varices, gastritis, erosive esophagitis or ulcers, and Mallory-Weiss tears.
- A history should inquire about symptoms of bleeding, changes to bowel movements, recent
- UGIB has a source *proximal* to ligament of Treitz, LGIB is distal
- First priority is to ensure pt is **hemodynamically stable!** - Remember you have to r/o serious causes before you can attribute bleeding to a benign cause like hemorrhoids! ###DDx LGIB - Colon Ca - Colitis - IBD (UC >> Crohn's) - Bacterial - Radiation - Diverticulosis - Angiodysplasia - Brisk UGIB - Anorectal causes - Hemorrhoids - Anal fissure - Rectal ulcer ###DDx UGIB - PUD - H. pylori (50%) - NSAIDs - Gastric hypersecrtion (e.g. Zollinger-Ellison) - Varices - Esophageal gastric - Gastritis/Gastropathy/duodenitis - Erosive esophagitis/ulcer - e.g. due to GERD - Mallory-Weiss tear - Vascular lesions - Dieulafoy's lesion (gives sudden massive UGIB) ###Hx - UGIB-predominant Sx: - N&V: Hematemesis, coffee-ground emesis - Melena - Epigastric pain - Vasovagal - LGIB-predominant Sx: - Diarrhea - Tenesmus - BRBPR - Hematochezia - Things wh/ can mimic stool changes: - Beet ingestion - Iron supplementation - Pepto-Bismol - Questions about bleeding: - Orthostatic hypotension Sx? - Amount of blood? - Blood just on TP? Mixed in w/ stool? - BM questions: changes in calibre, mucous - Recent C-scope or EGD? Recent radiation? - FHx of Colon Ca? - Coagulopathy issues: - NSAID use? - Use of anticoagulants? - Use of ASA? Clopidogrel? - EtOH use? - Known coagulopathies? ###PEx - Vitals! Esp HR & BP - w/ **orthostatics!** - JVP - Abdo exam, incl: - Ascites? - HSM? (may imply portal HTN) - Other signs of liver failure? - Anorectal exam - FOBT testing (esp if any mimic factors found on Hx) ###High-Risk Pts for GI Bleed - Make sure to add a PPI for cytoprotection in these pts: - Previous GI Bleed - ICU admission - Prolonged NSAID use - Sig EtOH use (Previous EGD? Varices?) ###Investigations - CBC (for Hb, Hct, plt) - PT, PTT/INR - Liver enzymes - BUN, Cr - BUN/Cr ratio is >36 in UGIB b/c GI resorbs the blood) - Consider EGD and/or C-scope - For unstable/recurrent GI bleed: - Arteriography - Tagged RBC scan ###Management - Initial Rx: - Fluid resusc - Transfuse (consider if >2L fluid needed) - Reverse coagulopathyies: FFP & vit K, Octiplex - For varices: octreotide 50 mcg IV bolus + 50 mcg/hr infusion - Can also try EGD band ligation - For PUD: PPI infusion if needed (e.g. Omeprazole 80 mg IV bolus, then 8 mg/h i nfusion) - For pts on ASA for CV risk, D/C ASA until 7d after bleed - Mallory-Weiss: usually stops spontaneously - Esophagitis/Gastritis: PPI - Diverticulosis and Angiodysplasia usually stop spontanteously, but can be trea ted endoscopically if needed