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Gastroenterology > 44 GI Bleed > Flashcards

44 GI Bleed Flashcards

Chapter 44. Gastrointestinal bleeding

1
Q

Most common cause of UGIB? 2nd most common cause?

A

Most common: ulcer

2nd: varices

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2
Q

Most common cause of LGIB? 2nd most common cause?

A

Most common: Hemorrhoids

2nd: vascular ectasias

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3
Q

GI bleeding manifested as hematemesis, coffee-grounds material, melena or hematochezia

A

Overt GI bleeding

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4
Q

GI presenting with symptoms of blood loss or anemia such as light headednes, syncope, angina, iron deficiency anema or positive fecal occult blood tests

A

Occult GI bleeding

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5
Q

What is infusion used to enhance clot stability in PUD and decrease further bleeding

A

80 mg IV bolus then 8 mg/hr infusion

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6
Q

What is the target intragastric pH to enhance clot stability in GI bleed

A

Intragastric pH of more than 6

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7
Q

True or false. High intermittent PPI are non inferior to constant infusion PPI therapy

A

True.

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8
Q

How many days can aspirin be re started in cardiac patient who has GI bleeding

A

As soon as possible in span of 1-7 days

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9
Q

What is classic history of Mallory Weiss tears?

A

Vomiting or retching or coughing prior to hematemesis especially in an alcoholic patient

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10
Q

How soon should endoscopy be done in cirrhotics with UGIB

A

Urgent endoscopy within 12 hours

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11
Q

Vasoactive medications given to esophageal varices and for how long

A 
Ocreotide
Somatostatin
Vapreotide
Terlipressin
For 2-5 days
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12
Q

When is TIPS consider in acute variceal bleeding in patients with advanced liver disease

A

First 1-2 days of hospitalization

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13
Q

Most important cause of gastric and duodenal erosion

A

NSAIDs

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14
Q

Endoscopically visualized breaks which are confined to the mucosa and do not cause major bleeding due to the absence of arteries and veins in the mucosa

A

Erosion

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15
Q

Percent small intestinal GIB account for up to what percent of cases?

A

5-10% of GIB cases

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16
Q

Most common cause of small intestinal GIB in adults more than 40 years

A

Vascular ectasia
Neoplasm
NSAID induced

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17
Q

Most common cause of significant small intestinal GIB in children

A

Meckels diverticulum

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18
Q

Which colon often present with diverticular bleeding

A

Right colon

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19
Q

True or false. Diverticular bleeding stop spontaneously in 10% of patients thus endoscopy should be done

A

False. Resolve spontaneously in 80-90% of patients

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20
Q

Syndrome presenting with bleeding vascular ectasias and aortic stenosis

A

Heyde’a syndrome

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21
Q

Best initial assessment of GIB

A

Heart rate and blood pressure

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22
Q

What does melena indicate on the status of GIB

A

Blood has been present in the GI tract for more than 14 hrs and as long as 3-5 days

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23
Q

What is the transfusion threshold in GIB

A

Hgb below 7 mg/dl

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24
Q

True or false. Hemoglobin and hematocrit may be normal in acute GIB due to proportionate reduction in plasma and red cell volume

A

True

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25
Q

How long it may take for the acute GIB blood loss be seen as decrease in hemoglobin count

A

As as 72 hour before Hgb/Hct drops

26
Q

True or false. When hematochezia is the presenting symptom of UGIB it is associated with hemodynamic instability and dropping hemoglobin

A

True

27
Q

How is intensive PPI done

A

IV bolus 80 mg then drip 8 mg/hr x 3 days OR
IV bolus 80 mg then IVTT 40-80 mg BID or 40 mg TID x 3 days
Then
Twice daily PPI for day 4-14
Then once daily PPI

28
Q 
Ulcer. Active bleeding or visible vessel
Endoscopic therapy?
Medical therapy?
Diet? 
Hospital stay?
A 
Active bleeding or visible vessel
Endoscopic therapy: Yes
Medical therapy: Intensive PPI
Diet: clear liquids for  2 days after endoscopy 
Hospital stay: 3 days after endoscopy
29
Q 
Ulcer: adherent clot
Endoscopic therapy?
Medical therapy?
Diet? 
Hospital stay?
A 
Ulcer: adherent clot
Endoscopic therapy: may do
Medical therapy: Intensive PPI
Diet: clear liquids for 2 days after endoscopy
Hospital stay: 3 days after endoscopy
30
Q 
Ulcer: flat pigmented spot
Endoscopic therapy?
Medical therapy?
Diet? 
Hospital stay?
A 
Ulcer: flat pigmented spot
Endoscopic therapy: no
Medical therapy: once daily PPI
Diet: clear liquids after endoscopy
Hospital stay 1-2 days after endoscopy
31
Q 
Esophageal varices
Endoscopic therapy?
Medical therapy?
Diet? 
Hospital stay
A

Esophageal varices
Endoscopic therapy: ligation
Medical therapy: Vasoactive drug
Diet clear liquids for 2 days after Endoscopic therapy
Hospital stay 3-5 days after Endoscopic therapy

32
Q 
Mallory Weiss Tears. Active bleeding
Endoscopic therapy?
Medical therapy?
Diet? 
Hospital stay
A 
Mallory Weiss Tears. Active bleeding
Endoscopic therapy Yes
Medical therapy: anti emetic if ongoing nausea
Diet clear liquids for 1 day endoscopy
Hospital stay 1-2 days after endoscopy
33
Q 
Mallory Weiss Tears. No active bleeding
Endoscopic therapy? 
Medical therapy?
Diet? 
Hospital stay
A 
Mallory Weiss Tears. No active bleeding 
Endoscopic therapy No 
Medical therapy: anti emetic if ongoing nausea 
Diet regular diet after endoscopy
Hospital stay discharge after endoscopy
34
Q 
Erosion.
Endoscopic therapy?
Medical therapy?
Diet? 
Hospital stay
A 
Erosion
Endoscopic therapy. No
Medical therapy. Once daily PPI
Diet: regular diet after endoscopy 
Hospital stay: discharge after endoscopy
35
Q

How is vasoactive drug ocreotide given?

A

Intravenous 50 ug bolus then 50 ug/h infusion for 2-5 days

36
Q

What promotility agent may be given before endoscopy to improve visualization

A

Erythromycin 250 mg IV before endoscopy

37
Q

When should upper endoscopy be done in most patients with UGIB

A

Within 24 hours

38
Q

True or false. Cirrhotics patients with UGIB should be antibiotics and vasoactive drug prior to endoscopy

A

True. Antibiotics to decrease infection and vasoactive drug to control bleeding

39
Q

True or false. In patients with hematochezia and hemodynamic instability and upper endoscopy may be done first to ry le out an UGIB before LGIB

A

True

40
Q

What is procedure of choice for most patients admitted for LGIB

A

Colonoscopy after oral lavage

41
Q

What procedure to do if LGIB is massive

A

CT angiography

42
Q

If no bleeding found on colonoscopy what is the next procedure

A

99Tc labeled red cell scan

43
Q

What is the initial test if patients with massive bleeding is suspected from the small intestines

A

CT angiography or 99Tc red blood cell scan prior to angiography
Others repeat EGD and colonoscopy as second look can detect 25% or bleeding

44
Q

Other clues to UGIB

A

Hyperactive bowel sounds

Elevated BUN

45
Q

What is included in the Glasgow Blatchford score

A 
BUN
Hgb
SBP
HR
Other markers
Melena
Syncope
Hepatice disease
Cardiac failure
46
Q

Algorithm for LGIB. No hemodynamic instability. Age more than 40 yrs old.

A

Colonoscopy

47
Q

Algorithm for LGIB. No hemodynamic instability. Age less than 40 yrs old. Minimal bleeding

A

Flexible sigmoidoscopy

48
Q

Algorithm for LGIB. No hemodynamic instability. Age less than 40 yrs old. Copious bleeding

A

Colonoscopy

49
Q

Algorithm for LGIB. No hemodynamic instability. Colonoscopy identified bleeding site. Bleeding persists.

A

Angiography then surgery if bleeding persists

50
Q

Algorithm for LGIB. No hemodynamic instability. Colonoscopy didn’t identify site.

A

Workup for small intestinal/ obscure bleeding site

51
Q

Algorithm for LGIB. Hemodynamic instability.

A

Upper endoscopy

52
Q

Algorithm for LGIB. Hemodynamic instability. Upper endoscopy done. No upper GI source. Able to bowel prep

A

Colonoscopy

53
Q

Algorithm for LGIB. Hemodynamic instability. Upper endoscopy done. No upper GI source. Not able to bowel prep

A

Angiography or CT angiography first.

54
Q

Algorithm for LGIB. Hemodynamic instability. Upper endoscopy done. Angiography done. Bleeding persists. Able to bowel prep.

A

Colonoscopy

55
Q

Algorithm for LGIB. Hemodynamic instability. Upper endoscopy done. Angiography done. Bleeding persists. Instability persist.

A

Surgeru with intra operative endoscopy

56
Q

Recommended for colorectal cancer screening at age 50 in average risk adults

A

Fecal occult blood testing

57
Q

At what age is fecal occult blood testing recommended

A

Age 50 years old

58
Q

Next step if second look procedure are negative

A

Video capsule endoscopy

59
Q

What is the disadvantage of video capsule endoscopy

A

Does not allow full visualization of the small intestines
No tissue sampling
Cannot apply therapy

60
Q

Used instead of video capsule endoscopy in patients with possible small bowel narrowing

A

CT enterography

61
Q

Nest step if video capsule endoscopy turned out negative

A

Deep enteroscopy

Gastroenterology (13 decks)

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