GI Bleed: NCLEX Priorities
Upper vs lower GI bleed: melena vs hematochezia, transfusion thresholds, EGD/colonoscopy.
GI bleeding ranges from minor to life-threatening. NCLEX tests recognition and initial management.
Upper vs lower
Upper (above ligament of Treitz): hematemesis, coffee-ground emesis, melena (black tarry stools). Causes: PUD, varices, gastritis, Mallory-Weiss. Lower: hematochezia (bright red blood per rectum). Causes: diverticulosis, hemorrhoids, AVMs, cancer, IBD.
Initial management
Two large-bore IVs, type & cross, NPO, fluid resuscitation. Transfuse for Hgb <7 (or <8 in cardiac disease). Reverse anticoagulation.
Workup
EGD for upper bleed. Colonoscopy for lower bleed (often after stabilization).
Variceal bleed specifically
Octreotide + antibiotics + endoscopy. Continue beta-blocker prophylaxis after.
Frequently asked
Hgb drops with bleed, when see it?
May take 6-12 hours to equilibrate. Don't rely on early Hgb.
NG lavage routine?
Less common now. Doesn't change outcomes significantly.
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