GI Bleed
EM Clerkship
Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD
4.9 • 816 Ratings
🗓️ 16 July 2017
⏱️ 10 minutes
🧾️ Download transcript
Summary
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
* GI Bleed Emergencies (EM Cases)* GI Bleed (emDOCs)
Transcript
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| 0:00.0 | Hello, med students. |
| 0:03.0 | My name is Zach Olson, and thank you for downloading this week's episode of the EM Clerkship Podcast. |
| 0:12.9 | Core content this week. |
| 0:15.6 | Here's your case. |
| 0:25.1 | We're going to hear. case. Okay, everybody, we called in. |
| 0:27.1 | I don't know if you guys had a chance. |
| 0:28.6 | We were just right around the corner. |
| 0:30.2 | This is Johan, 84 years old. |
| 0:32.5 | He's coming from a nursing home. |
| 0:34.4 | Staff notified us. |
| 0:36.4 | They noticed Tari Stools sometime yesterday morning and then they |
| 0:40.7 | decided to call us today at shift change so BP 100 over 60 pulse of 100 respiration is 20 just |
| 0:48.5 | have a history of dementia hypertension pneumonia a week ago the family's not in state and he's not really been talking to us. |
| 0:57.0 | So, yeah, bag of meds, you know, that's the story. |
| 1:02.0 | Anybody have any questions? |
| 1:04.0 | Yes, we did get a glucose. |
| 1:06.0 | Glucose is 110. |
| 1:08.0 | Anybody else? |
| 1:10.0 | All right, guys. Thank you. This is 110. Anybody else? |
| 1:11.7 | All right, guys. |
| 1:12.6 | Thank you. |
| 1:20.3 | Molina, dark Tari Stools. |
... |
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