Gastrointestinal Bleed 

Glasgow-Blatchford Bleeding Score (GBS) 

• Stratifies upper GI bleeding patients who are "low-risk" and candidates for outpatient management 

• Score of 1 can be managed outpatient 

• Higher score = higher risk, consider treating inpatient 

1. Which of the following is the correct definition?

a) Hematemesis is bright red stool

b) Hematochezia is blood in the vomit

c) Melena is dark, tarry stool

d) None of the above

2. Which of the following most commonly results in an upper GI bleed? 

a) Peptic ulcer disease

b) Diverticulosis

c) Colitis

d) Malignancy

3. All of the following drugs may cause a GI bleed except

a) Escitalopram

b) Apixaban

c) Meloxicam

d) Phenytoin

4. PPIs work to neutralize the acidic environment of the stomach. This can help heal GI bleeds because an acidic environment will worsen bleeding by

a) Decreasing pepsin 

b) Impairing platelet aggregation

c) Reducing blood clots

d) Increasing fibrinolysis

5. A patient presents with melena, petechiae on the arms and epigastric pain. Their labs are as follows:

[Brackets indicate reference range]

GGT: 69 [10-55 U/L]

ALT: 330 [10-65 U/L]

AST: 129 [10-38 U/L]

INR: 4.0 [0.9-1.2]

Albumin: 18 [34-50 g/L]

Which of the following would be the MOST appropriate treatment?

a) Pantoprazole 80 mg IV bolus then 8 mg/hr IV infusion x 72 hr and ciprofloxacin

b) Octreotide 50-100 mcg IV bolus followed by 25-50 mcg/hr infusion for up to 5 days and ciprofloxacin

c) Pantoprazole 80 mg IV bolus then 40 mg IV q 12 hr and ciprofloxacin

d) Pantoprazole 40 mg IV q 12 hr and octreotide 50-100 mcg IV bolus followed by 25-50 mcg/hr infusion for up to 5 days and ciprofloxacin