46 - Acute GI hemorrhage Flashcards
The ligament of Treitz is found in the ___ junction. The upper GI is until the __and the lower GI is from the beginning of the ___
duodenojejunal
duodenum
jejunum
Upper GI bleeding is defined as originating above the ___. It makes up to __% of the acute GI bleeding
ligament of Treitz
80
Most acute GI bleeding will resolve ___, but __% of cases will linger and require urgent and aggressive intervention. ___% mortality
spontaneously
15
10
The most common reasons for UGIB are: (2)
varices bleeding
PUD bleeding
Hematemesis=___
vomit of digested blood
Coffee ground=___
black blood due to the combination with gastric acid for a long period
Melena=___
black feces with intense smell- the blood was in the GI for >= 14 h. At least 50 cc of blood.
How can we decide if the melena is due to UGIB or LGIB?
insert NG tube and seek blood in the UGI
Hematochezia=___
fresh blood from the rectum w/o feces
what does hematochezia usually suggest? (2)
bleeding from a very low origin (sigma/rectum)
severe UGIB (usually with vascular instability and decreased Hb)
The first step when managing a patient with acute GI bleeding is ___, followed by ____, ____, ____, and finally ____ if the bleeding persists
initial assessment and resuscitation history and exam localize bleeding initiate therapy surgery
What does the initial assessment and resuscitation of acute GI bleeding consist of? (4)
ABC
magnitude of bleeding
appropriate monitoring
lab evaluation
What are the 5 indications for surgery in GI hemorrhage?
- hemodynamic instability despite vigorous resuscitation (>6 unit transfusion)
- failure of endoscopic techniques
- recurrent hemorrhage after initial stabilization (with >2 attempts of endoscopic hemostasis)
- shock associated with recurrent hemorrhage
- continued slow bleeding requiring >3 unit/day of transfusion
When loosing __% of the blood volume, BP will decrease in > than ___, HR> ___ when changing position (sitting->standing)
20
10
20
When loosing __-__%, HR >___ + low __
20-40
100
PP
When loosing >__% -> ___. Symptoms include: (4)
40 hemorrhagic shock mental status alteration agitation hypotension cold periphery
When a patients presents with acute GI hemorrhage we first must open ___ lines and perform ___
2
blood analysis
The blood analysis require when initially examining an acute hemorrhage patients include: (6). Remember to order 6 blood transfusion units
type and cross hematocrit platelets coagulation liver chemistry
How much fluids should be administrated to a patients with acute hemorrhage?
2 liters of bolus ringer
What is the recommended hematocrit levels we should try and achieve in an acute hemorrhage patient? young > ___%, adults > ___%
20
30
In an acute hemorrhage patient (especially with UGIB) remember to administrate IV ___, establish urine ___, and insert ___ to monitor the amount of bleeding and the content type.
PPI
catheter
NG tube
In UGIB ___ levels will increase
urea
EGD = ____
esophagus-gastro-duodenoscopy
EGD ___ should be performed in every massive GI bleeding, in order to decide the bleeding
origin (upper/lower)
EGD should be performed within the first __ h in stable acute hemorrhage patients.
24
EGD should be performed ___ in instable acute hemorrhage patients.
ASAP
Beside NGT and EGD, how else will you determine the origin of the bleeding? (3)
angiography
CT
tagged RBC scan
Obscure GI bleeding is defined as ___ or ___ bleeding, together with negative ____ test.
persistent
recurrent
endoscopic
___ score is used to assess the risk for ___and mortality. We use this score in order to decide if the patient should be ___, monitored, or go through emergency ___
Blatchford
re-bleeding
hospitalized
endoscopy
Name the criteria of the Blatchford score:
BUN
hemoglobin
systolic BP+HR
melena/syncope/HF/LF
Blatchford score does not take into account the ___ findings, and can be used for ___ assessment
endoscopic
initial
Rockwall score takes into account among other criteria, also ___ findings
endoscopic
Name the criteria of the Rockwall score:
age (<60, 61-79,>80) history (HF/LF/malignancy...) bleeding severity (BP<100, HR>100) blood transfusion necessity endoscopic findings
A patients with esophageal varices has a __% chance for rebleeding
60
A patients with gastric cancer has a __% chance for rebleeding
50
A patients with PUD s has a __% chance for rebleeding
28
A patients with duodenum ulcer has a __% chance for rebleeding
24
A patients with gastritis has a __% chance for rebleeding
15
A patients with Mallory Weiss syndrome has a __% chance for rebleeding
7.5
