Professional Documents
Culture Documents
• Labs
• CBC
• Serial HgB
• Platelets
• BMP
• BUN, Cr
• Type and Crossmatch
• Coagulation studies
• Imaging studies?
Sources of GI Bleeding
• Upper GI Tract
• Proximal to the Ligament of Treitz
• 70% of GI Bleeds
• Lower GI Tract
• Distal to the Ligament of Treitz
• 30% of GI Bleeds
Localization of Bleeding
• History
• NG Tube
• EGD
• Colonoscopy
• Tagged RBC Scan
• Angiography
Upper GI Bleed
• 50% present with hematemesis
• Hematochezia
• Blood in Toilet
• Clear NGT aspirate
• Normal Renal Function
• Usually Hemodynamically stable
Only 1/3 of patients with lower GI bleeds have positive
orthostatics (tilt test).
Lower GI Bleed
• Etiology of Lower Bleeds
• Diverticular-20%
• AVM-10%
• Malignancy-2-26%
• Inflammatory Bowel Disease-10%
• Ischemic Colitis
• Acute Infectious Colitis
• Radiation Colitis/Proctitis
• Aortoenteric Fistula
Diverticulosis
Diverticulitis-NOT A CAUSE OF
GI BLEEDING
Colonic Polyps
Malignancy
• Colon Carcinoma
Hemmorrhoids
Management of GI Bleed
• Oxygen
• IV Access-central line or two large bore
peripheral IV sites
• Isotonic saline for volume resuscitation
• Start transfusing blood products if the patient remains unstable despite
fluid boluses.
• Airway Protection
• Altered Mental Status and increased risk of aspiration with massive
upper GI bleed.
Management of GI Bleed
• ICU admit indications
• Significant bleeding with hemodynamic instability
• Transfusion
• Brisk Bleed, transfusing should be based on hemodynamic status, not
lab value of Hgb.
• Cardiopulmonary symptoms-cardiac ischemia or shortness of breath,
decreased pulse ox