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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