5 - GI Bleeding Flashcards
landmark separating upper vs lower GI bleed
ligament of treitz
no 1 cause of upper GI bleeds
peptic ulcer disease
top 5 causes of upper GI bleeds
peptic ulcer disease varices AVM mallory weiss tears tumors
steroids and ulcers
dont cause bleeding/ulcers on their own, but increase risk if also taking NSAIDs
management of upper GI bleed due to varices
goal Hgb 7-8
prophylactic abx - ceftriaxone
severity of bleeding from mallory weiss tears
not that bad - usually self limited
GI AVMs assoc w/ what conditions?
cirrhosis, renal failure, radiation exposure/therapy, collagen vascular disease, osler-weber-rendu syndrome
dieulafoy’s lesion
intermittent, recurrent upper GI bleed due to large caliber submucosal artery that has become exposed
aortoenteric fistula
can be caused by ateriosclerosis, aortic aneurysm, aortic infection or synthetic graft
usually in distal duodenum or in jejunum
need surgery to repair
bleeding can be quite severe
which tends to be larger volume - upper or lower GI bleeds?
lower
causes of lower GI bleeds
diverticulosis internal hemorrhoids ischemic colitis rectal ulcers colon angioma, radiation telangectasia inflammatory bowel dz post polypectomy ulcer
MCC lower GI bleed (overall vs outpatient)
diverticulosis - overall
internal hemorrhoidds - outpatient
who gets ischemic colitis?
old people with comorbidities that affect vasculature / blood flow
rectal ulcers assoc w/
fecal impaction, trauma, prolapse, ischemia
melena
black, tarry stools w/ foul smell
usually indicate upper GI bleed
GI bleed presentation
hemodynamic instability from dec blood volume
(reflex tachy, hypotension, orthostatic)
signs of anemia
hematemesis / hematochezia / melena
supplement that can cause GI bleeds
ginkgo
severe GI bleed resuscitation
2 large bore IVs
hemodynamic assessment - need transfusion?
NG lavage - may tell you source
intubation if vomiting blood, altered mental status or altered resp status
why do you want acid suppression in GI bleeds?
acid and pepsin “digest” the clot - will prolong bleeding
want pH>6
octreotide or somatostatin
reduce portal blood flow and dec arterial flow to stomach and duodenum
dec secretion of acid and pepsin
helps GI bleed to heal / dec volume of blood loss
most effective endoscopic treatments for upper GI bleeds
thermal + epi
mechanical + epi
