GI Bleed

Basic Categories



* Upper GI Bleed* Symptoms* Coffee ground emesis* Melena* Black tarry stool* Digested blood* Common causes* Peptic ulcer disease* Varices* Lower GI Bleed* Symptoms* Bright red blood per rectum (BRBPR)* Maroon/bloody stools* Common causes* Diverticulosis* Colon cancer* Angiodysplasia* AV Malformations



History



* Ask about risk factors for upper GI bleed* Peptic ulcer risk factors* NSAIDS* Steroids* History of ulcers* Varices risk factors* Heavy alcohol use* History of liver disease



Exam



* Abdominal exam* Usually minimal tenderness* If patient has severe tenderness/peritoneal signs consider alternative diagnosis* Perforation* Rectal exam* Identify stool color* Guaiac testing* Hemorrhoids* Are they bleeding* Anal fissures



Testing Plan



* CBC* Looking for anemia* Electrolytes* Elevated BUN* Commonly present in upper GI bleed* Coagulation panel* Type and screen



Treatment Plan



* Proton pump inhibitor (upper GI bleeds)* “-prazoles” such as pantoprazole* Octreotide/Antibiotics if varies suspected



Disposition



* Most upper GI bleeds get admitted* Lower GI bleeds depend on risk factors* Comorbidities* Clinical findings/stability* Vital signs* Hemoglobin/Hematocrit



Additional Reading



* GI Bleed Emergencies (EM Cases)* GI Bleed (emDOCs)