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• Labs
• CBC
• Serial HgB
• Platelets
• BMP
• BUN, Cr
• Type and Crossmatch
• Coagulation studies
• Imaging studies?
Sources of GI Bleeding
• Upper GI Tract
• Proximal to the Ligament of Treitz
• 70% of GI Bleeds
• Lower GI Tract
• Distal to the Ligament of Treitz
• 30% of GI Bleeds
Localization of Bleeding
• History
• NG Tube
• EGD
• Colonoscopy
• Tagged RBC Scan
• Angiography
Upper GI Bleed
• 50% present with hematemesis
• Hematochezia
• Blood in Toilet
• Clear NGT aspirate
• Normal Renal Function
• Usually Hemodynamically stable
Only 1/3 of patients with lower GI bleeds
have positive orthostatics (tilt test).
Lower GI Bleed
• Airway Protection
• Altered Mental Status and increased risk of aspiration with
massive upper GI bleed.
Management of GI Bleed
• ICU admit indications
• Significant bleeding with hemodynamic instability
• Transfusion
• Brisk Bleed, transfusing should be based on hemodynamic
status, not lab value of Hgb.
• Cardiopulmonary symptoms-cardiac ischemia or shortness of
breath, decreased pulse ox