GI Bleed

Summary: <br> Basic Categories<br> <br> <br> <br> * 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<br> <br> <br> <br> History<br> <br> <br> <br> * 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<br> <br> <br> <br> Exam<br> <br> <br> <br> * 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<br> <br> <br> <br> Testing Plan<br> <br> <br> <br> * CBC* Looking for anemia* Electrolytes* Elevated BUN* Commonly present in upper GI bleed* Coagulation panel* Type and screen<br> <br> <br> <br> Treatment Plan<br> <br> <br> <br> * Proton pump inhibitor (upper GI bleeds)* “-prazoles” such as pantoprazole* Octreotide/Antibiotics if varies suspected<br> <br> <br> <br> Disposition<br> <br> <br> <br> * Most upper GI bleeds get admitted* Lower GI bleeds depend on risk factors* Comorbidities* Clinical findings/stability* Vital signs* Hemoglobin/Hematocrit<br> <br> <br> <br> Additional Reading<br> <br> <br> <br> * GI Bleed Emergencies <a href="https://emergencymedicinecases.com/gi-bleed-emergencies-part-1/">(EM Cases)</a>* GI Bleed <a href="http://www.emdocs.net/em3am-gi-bleed/">(emDOCs)</a><br>