UGIB
Features	·       proximal to ligament of Treitz ·       Multiple causes: ·       PUD ·       Varices ·       Mallory weiss tear
S/S	Bleeding from mouth
Dx	·       H&P ·       CBC ·       NGT ·       Endoscopy
Tx	·       1˚ ABC ·       intubation may be indicated ·       IVF ·       blood transfusions to raise hematocrit / hemodynamic instability (7) ·       2˚ Treat U/C ·       PPIs for PUD ·       octreotide for varices ·       Surgical intervention ·       varices: endoscopic banding/sclerotherapy  ·       Transjugular intrahepatic portasystemic shunt (TIPS) ·       consider in patients with recurrent variceal bleeding (3rd episode)

	LGIB
Features	·       distal to ligament of Treitz ·       Multiple causes: ·       mcc is diverticulosis ·       Hemorrhoids (rx surgery)
S/S	Bleeding from rectum
Dx	·       Anoscope / sigmoidoscopy / colonoscopy  ·       if bleeding minimal and patient is stable ·       if pt is over 40 and no warning signs, → colonoscopy to r/o malignancy ·       NGT or endoscopy → r/o UGIB ·       Angiography  ·       Tagged-RBC study
Tx	·       1˚ Stabilize patient (ABC), give fluids, type and cross  ·       IV fluids and transfusions for hemodynamic stability ·       When to transfuse blood? Hgb 7 / Hct 30 ·       When to give PLT? if less than 50

	Blood per rectum DDx
Hemorrhoids	·       Painless ·       Associated w/ bowel movement ·       Coats the stool
Anal fissures	·       PAINFUL DEFECATION ·       Bright blood
Polyps	·       Asx ·       Minimal bleeding
Proctitis	·       Intermittent bleeding ·       Passage of mucus
Rectal ulcers	·       Bleeding ·       Mucus ·       Straining during defecation
Cancer	·       Hematochezia ·       Pain ·       Change in bowel habits

	Mesenteric Ischemia (MI of GI)
Features	·       basically, gut MI ·       can be chronic or acute ·       Atherosclerosis RF (smoking, dyslipidemia)
S/S	·       pain out of proportion to PEx ·       Postprandial, crampy ·       pt has hx of vasculopathy (angina) ·       pt avoids eating, because it hurts (sign of chronic mesenteric ischemia) ·       Weight loss
Dx	·       CT Angio
Tx	·       Resect if necrosis ·       Revascularize ·       Avoid RFs

	Ischemic colitis
Features	·       watershed area ·       Most commonly involves splenic flexure ·       pt gets hypotensive, the area dies
S/S	In general, the initial presentation of patients with ischemic colitis includes the acute onset of lower abdominal pain, followed by bloody diarrhea within 12-24 hours.
Dx	Abdominal x-ray and CT scan of the abdomen may show changes such as thumb-printing (indicating submucosal edema) and hemorrhage. However, in the early stages, there are often no signs.

	Angiodysplasia
Features	·       AV Malformation + dilated submucosal veins ·       Associated w/ Renal dz + VW factor defeciency ·       Also Associated w/ AS (can cause VW factor defeciency) ·       Common in Right colon, but can happens anywhere in GI tract
S/S	·       Painless bleeding ·       Bleeding is slow (melena), not usually fresh blood ·       DDx from others by: ·       No anal sx (hemorrhoids) ·       No diverticula or masses on colonoscopy (Cancer/ diverticulosis) ·       Bleeding of diverticulosis is usually heavier
Dx	·       Colonoscopy
Tx	·       Asx: No Tx ·       Bleeding/Anemic: Endoscopy + cautery

GI Bleeding

Upper gastrointestinal bleeding (UGIB), likely due to NSAIDs drug use. 1˚ Large-bores + IVF 2˚ IV PPI * Stable + no comorbid conditions → if hgb <7 = RBC A higher threshold of hemoglobin <9 g/dL can be considered for patients with acute coronary syndrome. INR >1.6 = FFP Severe coagulopathy (liver dz, DIC) = FFP * – PPI ⤵️ Rebleeding and the need for transfusions, and help stabilize clots in patients with UGIB. – Somatostatin analogs such as octreotide are a mainstay in management of variceal bleeding. – PLT <50k + ACTIVE BLEEDING = give PLT – PLT <10k regardless of bleeding = give PLT