KNOWLEDGE - students should be able to appreciate the following:
- Gastrointestinal bleeding is a life-threatening condition until proven otherwise.
- The initial management of the patient with gastrointestinal bleeding is the same regardless of the etiology. Lifesaving measures such as repletion of intravascular volume and airway protection are critical in every patient with GI bleeding.
- Melena (usually indicating an upper GI source) is the most frequent cause of major GI bleeding, but all black stools are not melena.
- Hematochezia is usually a manifestation of lower GI bleeding but can be a manifestation of severe upper GI bleeding.
- The most common cause of major upper GI bleeding is the peptic disorders. Diverticulosis is a common cause of major lower GI bleeding.
- Endoscopy is the initial diagnostic test and therapeutic modality of choice in upper GI bleeding and has predictive value of rebleeding.
- Colonoscopy (after cessation of bleeding and colonic cleansing) is the test of choice in lower GI bleeding.
- Mortality and morbidity from GI bleeding has not changed significantly over the past 50 years in the U.S.
SKILLS – students should be able to demonstrate the following skills:
- Obtain an accurate history and perform a rapid physical examination on the bleeding patient, while resuscitative measures are being instituted
- Know the basic resuscitative measures in the GI bleeder (NG tube placement, volume replacement, oxygen administration, and laboratory evaluation).
- Correctly recommend when to use endoscopic procedures and when to use angiography in the bleeding patient.
- Know what pharmacologic agents are available for the GI bleeder and their efficacy.
- Correctly recommend when to call for surgical consultation in the GI bleeder.
ATTITUDES AND PROFESSIONAL BEHAVIORS:
- Students should appreciate the scope of GI bleeding in the U.S. and its impact on the patient. Timing of appropriate tests is paramount for rapid, accurate diagnosis in the GI bleeder in order that appropriate therapy be instituted as soon as possible.
- Yamada, Tadataka. Handbook of Gastroenterology . 2000, Chap 4 (The Medicine Education Office, 7604, has a copy of this reference.)