46 - Acute GI hemorrhage

Question 1

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 ___

Answer 1

duodenojejunal
duodenum
jejunum

Question 2

Upper GI bleeding is defined as originating above the ___. It makes up to __% of the acute GI bleeding

Answer 2

ligament of Treitz

80

Question 3

Most acute GI bleeding will resolve ___, but __% of cases will linger and require urgent and aggressive intervention. ___% mortality

Answer 3

spontaneously
15
10

Question 4

The most common reasons for UGIB are: (2)

Answer 4

varices bleeding

PUD bleeding

Question 5

Hematemesis=___

Answer 5

vomit of digested blood

Question 6

Coffee ground=___

Answer 6

black blood due to the combination with gastric acid for a long period

Question 7

Melena=___

Answer 7

black feces with intense smell- the blood was in the GI for >= 14 h. At least 50 cc of blood.

Question 8

How can we decide if the melena is due to UGIB or LGIB?

Answer 8

insert NG tube and seek blood in the UGI

Question 9

Hematochezia=___

Answer 9

fresh blood from the rectum w/o feces

Question 10

what does hematochezia usually suggest? (2)

Answer 10

bleeding from a very low origin (sigma/rectum)

severe UGIB (usually with vascular instability and decreased Hb)

Question 11

The first step when managing a patient with acute GI bleeding is ___, followed by ____, ____, ____, and finally ____ if the bleeding persists

Answer 11

initial assessment and resuscitation
history and exam
localize bleeding
initiate therapy
surgery

Question 12

What does the initial assessment and resuscitation of acute GI bleeding consist of? (4)

Answer 12

ABC
magnitude of bleeding
appropriate monitoring
lab evaluation

Question 13

What are the 5 indications for surgery in GI hemorrhage?

Answer 13

1. hemodynamic instability despite vigorous resuscitation (>6 unit transfusion)
2. failure of endoscopic techniques
3. recurrent hemorrhage after initial stabilization (with >2 attempts of endoscopic hemostasis)
4. shock associated with recurrent hemorrhage
5. continued slow bleeding requiring >3 unit/day of transfusion

Question 14

When loosing __% of the blood volume, BP will decrease in > than ___, HR> ___ when changing position (sitting->standing)

Answer 14

20
10
20

Question 15

When loosing __-__%, HR >___ + low __

Answer 15

20-40
100
PP

Question 16

When loosing >__% -> ___. Symptoms include: (4)

Answer 16

40
hemorrhagic shock
mental status alteration
agitation
hypotension
cold periphery

Question 17

When a patients presents with acute GI hemorrhage we first must open ___ lines and perform ___

Answer 17

2

blood analysis

Question 18

The blood analysis require when initially examining an acute hemorrhage patients include: (6). Remember to order 6 blood transfusion units

Answer 18

type and cross
hematocrit
platelets
coagulation
liver 
chemistry

Question 19

How much fluids should be administrated to a patients with acute hemorrhage?

Answer 19

2 liters of bolus ringer

Question 20

What is the recommended hematocrit levels we should try and achieve in an acute hemorrhage patient? young > ___%, adults > ___%

Answer 20

20

30

Question 21

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.

Answer 21

PPI
catheter
NG tube

Question 22

In UGIB ___ levels will increase

Answer 22

urea

Question 23

EGD = ____

Answer 23

esophagus-gastro-duodenoscopy

Question 24

EGD ___ should be performed in every massive GI bleeding, in order to decide the bleeding

Answer 24

origin (upper/lower)

Question 25

EGD should be performed within the first __ h in stable acute hemorrhage patients.

Answer 25

24

Question 26

EGD should be performed ___ in instable acute hemorrhage patients.

Answer 26

ASAP

Question 27

Beside NGT and EGD, how else will you determine the origin of the bleeding? (3)

Answer 27

angiography
CT
tagged RBC scan

Question 28

Obscure GI bleeding is defined as ___ or ___ bleeding, together with negative ____ test.

Answer 28

persistent
recurrent
endoscopic

Question 29

___ 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 ___

Answer 29

Blatchford
re-bleeding
hospitalized
endoscopy

Question 30

Name the criteria of the Blatchford score:

Answer 30

BUN
hemoglobin
systolic BP+HR
melena/syncope/HF/LF

Question 31

Blatchford score does not take into account the ___ findings, and can be used for ___ assessment

Answer 31

endoscopic

initial

Question 32

Rockwall score takes into account among other criteria, also ___ findings

Answer 32

endoscopic

Question 33

Name the criteria of the Rockwall score:

Answer 33

age (<60, 61-79,>80)
history (HF/LF/malignancy...)
bleeding severity (BP<100, HR>100)
blood transfusion necessity
endoscopic findings

Question 34

A patients with esophageal varices has a __% chance for rebleeding

Answer 34

60

Question 35

A patients with gastric cancer has a __% chance for rebleeding

Answer 35

50

Question 36

A patients with PUD s has a __% chance for rebleeding

Answer 36

28

Question 37

A patients with duodenum ulcer has a __% chance for rebleeding

Answer 37

24

Question 38

A patients with gastritis has a __% chance for rebleeding

Answer 38

15

Question 39

A patients with Mallory Weiss syndrome has a __% chance for rebleeding

Answer 39

7.5