Surgery - Upper Gi Bleed

Front 1

Name 5 common causes of an upper GI bleed:

Back 1

1) Duodenal ulcers
2) Gastric ulcers
3) Acute gastritis
4) Gastroesophageal varices
5) Mallory-Weiss syndrome

Front 2

When speaking of "upper" GI bleeds, how far down the digestive tract are we talking?

Back 2

From mouth to end of duodenum (ligament of Treitz)

Front 3

What is a Mallory-Weiss tear?

Back 3

Tear at the junction of the esophagus and stomach caused by severe retching or vomiting.

Front 4

Name a test (not endoscopy or imaging) that can confirm that the source of the bleeding is upper rather than lower?

Back 4

NG tube aspiration (if blood comes up, we know it's in the upper GI tract)

Front 5

What can you do during endoscopy to resolve bleeding?

Back 5

Cauterization, close varices, inject epinephrine

Front 6

What is the most useful diagnostic technique employed for upper GI bleeding?

Back 6

Endoscopy

Front 7

Name two non-laboratory tests you would do to investigate upper GI bleeding.

Back 7

1) NG aspiration
2) Endoscopy

Front 8

What blood tests would you want when investigating an upper GI bleed?

Back 8

CBC to check for anemia, coags, (INR, PTT), LFTs to investigate liver disease, blood type and match,

Front 9

Why might creatinine be elevated in patients with upper GI bleeds?

Back 9

Because of absorption of blood in the stomach.

Front 10

What is the initial treatment for upper GI bleeds?

Back 10

Fluid resuscitation
NG drainage
Interventional endoscopy

Front 11

How does GI bleeding present?

Back 11

Blood can pass through the mouth as hematemesis/coffee ground emesis or through the anus as hematochezia/melena/fecal occult blood.

In the first scenario the likely source of the blood is an upper GI bleed. The differential diagnosis includes:

-acute gastritis
-duodenal ulcers
-gastric ulcers
-gastroesophageal varices
-Mallory-Weiss syndrome

In the case of blood passing per rectum the source may be either an upper or lower GI bleed.

A differential diagnosis for lower GI bleeding includes:

Colorectal cancer
Arteriovascular malformations
Diverticular disease



Inflammatory bowel disease
Anorectal disease
Meckel's diverticulum
Ischemic colitis

Front 12

Describe the workup for a suspected GI bleed.

Back 12

1) Bloodwork:
CBC, lytes, BUN/creatinine, coagulation studies (INR and PTT), blood type and cross match

2) Nasogastric tube suction
-If you get blood up, it's upper GI. If you don't, it doesn't rule out upper GI.

3) Endoscopy for upper GI bleed

4) Angiography (e.g. CT angiogram)

5) Endoscopy