Evaluation of Upper GI Bleed
General presentation of Upper GI bleeding.
What is hematemesis or melena?
(Can be hematochezia if very brisk, like for infants or others with rapid transit time or massive UGI bleeding)
General presentation of Lower GI bleeding.
What is hematochezia?
(Can be melena if from proximal small bowel)
at least one consultant you should consider calling
Who are gastroenterologists, surgeons, intensivists, or interventional radiologists?
The ABC's of stabilization.
What is Airway, Breathing, and Circulation?
This is a medicine that can cause melena-like stool.
What is iron, bismuth (Pepto-Bismol, Maalox), or activated charcoal?
Medicines that can damage the gastric mucosa, cause esophagitis, and increase the risk of mucocutaneous bleeding.
What are NSAIDs?
(Corticosteroids damage gastric mucosa, too; doxycycline can also cause esophagitis; other anticoagulants like heparin/warfarin can increase risk of mucocutaneous bleeding)
The most common cause of LGI bleeds in neonates to school-aged children.
What is an anorectal fissure?
The type of IV fluids you would give as bolus.
What are isotonic crystalloids (e.g. Normal Saline or Lactated Ringers)?
Empiric medicine that is given until an UGI bleed is ruled out.
What is a PPI?
This is a food/drink that can cause red-colored stools.
What are
- foods with red skin: beets, tomates, apples
- food with red food coloring: Kool-Aid/fruit punch, red licorice, spicy snacks?
Three common causes of UGI Bleeding in children.
What are:
-Ingestions (toxin, foreign body)
-Mallory-Weiss tear
-Gastritis/esophagitis/peptic ulcer
-Vascular malformations
-Esophageal varices?
Three common causes of LGI bleeding in children.
What are:
- Anorectal fissures
- Necrotizing enterocolitis (neonates)
- Hirschsprung Disease (neonate-infant)
- Allergic colitis (neonate-toddler)
- Intussusception (infant-toddler)
- Infectious colitis (infant+)
- Meckel Diverticulum (toddler+)
- Henoch-Schonlein purpura (toddler+)
- Inflammatory Bowel Disease (toddler+)
The pediatric dose for an IVF bolus.
What is 10-20 mg/kg?
The vitamin that may help correct coagulopathy in liver disease, prolonged PT, or hemorrhagic disease of the newborn.
What is Vitamin K?
This medicine can cause red stools.
What is Cefdinir?
Imaging you might order for UGI Bleeding.
(Hint: esophageal varices, ingesting foreign body)
What is an abdominal ultrasound (can follow with abdominal CT with contrast, abdominal MRI, or UGI series) for liver disease/portal hypertension?
What are X-rays for radiopaque foreign bodies?
Labs you may consider getting if your patient presents with bloody diarrhea +/- fever.
What is a stool bacterial culture (Salmonella, Shigella, Yersinia, Campylobacter), a stool ova & parasite, a stool test for E Coli O157:H7, a stool test for C.dif Toxin, a stool calprotectin or lactoferrin?
(Consider Entamoeba histolytica or Trichuris trichiura if recent travel to endemic areas)
(Just 1 correct for points)
(You can transfuse earlier if concerning clinical picture, or if needed for procedural purposes)
When platelets are less than _____, you should consider giving a platelet transfusion.
What is 50,000 (before minor surgery)?
(Needs to be >100,000 before major surgery)
This food can cause melena-like stool.
What is spinach, blueberries, plums, grapes, chocolate, black licorice?
In addition to an EGD, ____ may increase visibility of an UGI bleeding for diagnostic purposes and even help for management of UGI bleeding.
What is an NG Tube?
(NGT lavage will also remove particulate matter, fresh blood, and clots to facilitate endoscopy and decrease the risk of aspiration.)
Imaging you might order for LGI bleeding (hint: intussusception, volvulus, ischemia, bleeding of unknown origin).
What is:
- Air Contrast Enema for intussusception
- Upper GI series +/- small bowel follow-through for volvulus
- Abdominal CT for ischemia
- Meckel scan, capsule endoscopy, RBC-scan, CTA for bleeding of unknown origin?
You should transfuse ______ if fibrinogen is low (<100).
What is cryoprecipitate?
You should transfuse _____ if INR >1.5.
What is FFP?
This food can give a false positive FOBT.
What is rare red meat, turnips, or horseradish?