Answer: The skin examination can be helpful for suggesting a potential source if certain stigmata are present. Lymphadenopathy or abdominal masses may suggest sources for intra-abdominal pathology SKIN FINDINGS IN CONDITIONS THAT CAUSE GI BLEEDING Disease Associated skin findings Peutz-Jeghers Pigmented macules on lips, palms, soles Malignant melanoma Melanoma Hereditary hemorrhagic telangiectasias Telangiectasias on lips, [...]

Answer: Duodenal and gastric ulcers Esophageal or gastric varices in the cirrhotic patient Mallory-Weiss tears (most commonly seen in alcoholic patients or patients with forceful vomiting) Erosive gastritis as a result of nonsteroidal anti-inflammatory drugs (NSAIDs) or in intubated ICU patients Reference: Feczko PJ, Halpert RD (eds): Case Review: Gastrointestinal Imaging. St. Louis, Mosby, 2000.

 Answer: The presence of a GI bleed should be confirmed by inspecting the stool for melena or hematochezia and the NG tube aspirate for blood. The site of bleeding can frequently be determined from the patient’s complaints. Upper GI bleeding often presents with hematemesis combined with melena; hematochezia with a negative NG aspirate suggests a [...]

Answer: A good rule of thumb is that blood transfusions should be given as quickly as the patient has lost blood. For example, if the patient presents with massive hematochezia and is hemodynamically compromised, packed red blood cells should be given as quickly as possible. On the other hand, the patient who presents with iron [...]

Answer: If there are signs of an acute, life-threatening bleed and an unstable condition, aggressive resuscitation and evaluation for the source must be under taken immediately. Placement of a nasogastric (NG) tube to assess for evidence of an upper GI source and, if present, to document the rapidity of bleeding should be done at this [...]

Answer: In any patient presenting with acute GI bleeding, the key word is resuscitation! The initial approach should include a rapid assessment to gauge the urgency of the situation, especially whether the patient is hemodynamically stable or unstable (blood pressure, pressure, and signs of orthostasis must be obtained). Venous access should be obtained with a [...]

Answer: Hematemesis: vomiting of blood. The blood may be a fresh, bright red in color or like coffee grounds. Melena: black, tarry, foul-smelling stool. Hematochezia: bright red blood per rectum, blood mixed with stool, bloody diarrhea, or clots. Occult GI blood loss: normal-appearing stool that is hemoccult-positive. Symptoms only: syncope, dyspnea, angina, palpitations, or shock. [...]