1. -GI bleeding is a/w 10% MORTALITY, THUS 1st: stabilize by ABC; 2nd: NASOGASTRIC TUBE to determain if the source of the bleeding is from the upper or the lower G.I.; -Melena(black digested stool) is from upper G.I. Bleeding of 50ml; -Hematochezia ( fresh blood with stool ) is from sever upper OR lower GI bleeding; (upper= Melena, hematemsis, hematochesia; Lower= hematochesia);- the Ligament of Treitz is at the duodenojejuna; - Bleeding proxmal to this ligament is upper GI bleeding, and bleeding distal to this ligament is lower GI bleeding.;Orthostatic hypotension (aka postural hypotension)BP falls greater than 20/10 mm H when the person stands up; Basic Metabolic Panel (aka: chem 7, Chemistry,BMP) BMP includes:Glucose, Ca, Na, K, CO2, Cl,BUN,Creatinine; liver function profile test (LFT): includes the levels of AST,ALT, ALP, Protein and Albumin, & Direct and indirect Bilirubin; Bleeding Profile: includes the test for PT, aPTT, & INR; - GI bleeding with INR more then 1.5, or increased PT Rx: fresh frozen plasma -uremic patients with GI bleeding Rx: dismopressin, -Start Packed-RBC(PRBC) if Hematocrit(Hct) is 25-30% or hemoglobin(HB) is 7gm/dL ; - 1unit of PRBCs will raise the Hct 3-4% and Hb by 1 gm/dl.;-P.O.50mg Fe increase hemoglobin(HB) 1.0 gm/dL per week; - stored blood has citrate & K; -citrate toxicity is alkalosis & hypo-Ca, Rx: slow Bl infusion & I.V. CaCl; - transfus 1 Unite of FFP for every 5 unites of pRBC;
2. GI bleeding
   1. 1st: vitals
      1. I. Tachycardia
      2. II. orthostatic Hpotetion
      3. III.Shock=systolic BP less then 100
         1. must give I.V. Normal Saline, continuous; give PRBC if more then 2L. NS is given
   2. 2nd: Rx: ABC
      1. Stat 2 I.V. 18G w/
      2. Clear airway, keep NPO
         1. nasogastric suction
      3. continuous cardiovascular monitor of:
         1. BP
         2. cardiac
         3. pulse oximetry
   3. 3ed: Physical Exam after stablizing the pt.
      1. GI with Digital rectal exam & anoscopy
      2. HEN, CNS,CVS, & Lungs
   4. 4th: order tests
      1. CBC w/ Differential, and cross matching
      2. BMP
         1. BUN & Creatinine
         2. K, Na, Ca,Cl,HCO3,Glucose
      3. LFT
      4. bleeding profile
         1. PT, aPTT, INR
      5. Nasogastric Tube Lavage
3. Lower GI bleeding
4. PEPTIC ULCER DISEASE, most common cause of UGB; Hx.
5. PORTAL HYPERTENTION, 20% of all cases of UGB; Hx liver disease
6. MALLORY-WEISS TEARS, 10% of all UGB, Hx: repeated vomiting, or alcoholism
7. VASCULAR ANOMALIES, 5% of UGB, Hx: CRF, CREST synd., telangiectasia
8. GASTRIC CANCER-rare
9. EROSIVE GASTRITIS -rare