Welcome back to another edition of the IBCC podcast. I'm here with Adam Thomas. We're going to talk today about GI bleeding.

Josh, I got to say I'm really excited for this one as a learner and an emerge talk because this pathway that you give us is really clear.

Because this spectrum of GI bleeding I think is sometimes all over the map from kind of that patient who's totally stable looking at you eating their turkey sandwich and has a low hemoglobin

to that exorcist level mass of upper GI bleed.

Let's go through this podcast, differential diagnosis of a GI bleed and walk our learners

through all that evidence-based approach you got for us today.

So I think usually GI bleed isn't a huge diagnostic conundrum, but there are a few pitfalls

to be aware of. The first one would be posterior epistaxis. People can have massive posterior

epistaxis, and sometimes that can manifest as a GI bleed. You know, patients are swallowing

the blood. They can have dark terry stools, and it can really look like a massive GI bleed.

So that's something to be aware of. And the treatment for that is obviously totally different.

So that's not something you'd want to miss. And the other thing would be people can have bloody diarrhea,

if they have colitis or mesenteric aschemia. And those patients technically do have a GI bleed,

but the bleeding is not the primary problem. So that's something else you'd want to differentiate

out. And we're definitely not going to talk about that today. We start with our differential

diagnosis, and then we go into risk stratification and assessment. And here are the major

topics we're going to cover are hemoglobin, hemodynamics, coagulation, signs of bleeding, cirrhosis,

and then overall fitness.

So as far as hemoglobin and coagulation, I think people generally get this backwards.

So the lower the hemoglobin is, the more comfortable I am, and that's going to sound counterintuitive.

But if a patient walks into the emergency room with a hemoglobin of four, and they're not dead,

that means that they've been slowly bleeding for a while.

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