Surgery Oral Exam: Gi Bleeding

Front 1

Upper GI bleed H&P:

Back 1

Hematemesis, melena, syncope,
shock, fatigue, coffee-ground emesis,hematochezia, epigastric discomfort,
epigastric tenderness, signs of
hypovolemia, guaiac-positive stools

Front 2

Upper GI bleed: risk factors

Back 2

Alcohol, cigarettes, liver disease, burn/
trauma, aspirin/NSAIDs, vomiting,
sepsis, steroids, previous UGI bleeding,
history of peptic ulcer disease (PUD),
esophageal varices, portal hypertension,
splenic vein thrombosis, abdominal aorticaneurysm repair (aortoenteric fistula),
burn injury, trauma

Front 3

Upper GI bleed : differential: common

Back 3

1. Acute gastritis
2. Duodenal ulcer
3. Esophageal varices4. Gastric ulcer
5. Esophageal
6. Mallory-Weiss tear

Front 4

Upper GI bleed: uncommon differential:

Back 4

Gastric cancer, hemobilia, duodenal
diverticula, gastric volvulus, Boerhaave’ssyndrome, aortoenteric fistula,
paraesophageal hiatal hernia, epistaxis,
NGT irritation, Dieulafoy’s ulcer,
angiodysplasia

Front 5

Upper GI bleed: labs and imaging:

Back 5

NGT aspirate, abdominal x-ray,endoscopy (EGD)
Chem-7, bilirubin, LFTs, CBC,
type & cross, PT/PTT, amylase

Front 6

Upper GI bleed: intervention:

Back 6

1. IVFs (16 G or larger peripheral
IVS  2), Foley catheter (monitor
fluid status)
2. NGT suction (determine rate and
amount of blood)
3. Water lavage (use warm H2O—will
remove clots)
4. EGD: endoscopy (determine etiology/location of bleeding and possible
treatment—coagulate bleeders)

Front 7

Upper GI bleed: surgical management:

Back 7

Refractory or recurrent bleeding and siteknown, 3 u PRBCS to stabilize or 6 u PRBCs overall requires surgical interventions. Look at lecture on GI bleed by blazer

Front 8

Lower GI bleed:H&P

Back 8

Hematochezia (bright red blood per
rectum [BRBPR]), with or without
abdominal pain, melena, anorexia, fatigue,syncope, shortness of breath, shock, orthostasis

Front 9

Lower GI bleed: differential diagnosis:

Back 9

Diverticulosis (usually right-sided in
severe hemorrhage), vascular ectasia,
colon cancer, hemorrhoids, trauma,
hereditary hemorrhagic telangiectasia,
intussusception, volvulus, ischemic colitis,IBD (especially ulcerative colitis),
anticoagulation, rectal cancer, Meckel’s
diverticulum (with ectopic gastric
mucosa), stercoral ulcer (ulcer from hard
stool), infectious colitis, aortoenteric
fistula, chemotherapy, irradiation injury,
infarcted bowel, strangulated hernia, anal
fissure

Front 10

Lower GI bleed: labs and imaging:

Back 10

CBC, Chem-7, PT/PTT, type and cross
NGT aspiration
(to rule out UGI bleeding; bile or blood
must be seen; otherwise, perform EGD),anoscopy/proctoscopic exam
Colonoscopy tagged RBCs scan angiogram

Front 11

Lower GI bleeding: management and intervention:

Back 11

IVFs: lactated Ringer’s; packed red bloodcells as needed, IV  2, Foley catheter tofollow urine output, d/c aspirin, NGT
Colonoscopy: Laser or electrocoagulation; local epinephrine injection
Known bleeding location: segmental resection
Unknown exploratory lapsed total collections as last resort