5. Upper GI Bleeding Flashcards
What are the 2 types of UGIB?
- Variceal
- Non-variceal
What are the subtypes of non-variceal UGIB?
- peptic ulcer disease
- stress related mucosal disease
- Mallory-Weiss tear
What are the common causes of PUD?
NSAID use
H. pylori infection
What are common causes of variceal UGIB?
- cirrhosis
- portal HTN
What landmark defines an upper GI source?
above the ligament of Treitz
What are some distinguishing symptoms of UGIB?
- hematemesis
- melena
- hematochezia
What is hematemesis?
- vomiting blood
- can look like coffee grounds
What is melena?
dark, digested blood in stool (tar-like)
What is hematochezia?
BRBPR
bright red blood per rectum
What is the mainstay therapy for UGIB?
endoscopy
NSAID induced gastropathy is due to inhibition of what?
COX-1
What are risk factors for continued bleeding/ recurrence?
Clinical: age (>65), shock, comorbidities, low Hgb, melena
Lab: ↓SBP, ↓Hgb, ↑ BUN, ↑ liver enzymes
Describe an ulcer that is unlikely to re-bleed?
- clean based ulcer
- non-protuberant pigmented clot
What ulcer characteristics require intervention?
- adherent clot
- non-bleeding visible vessel
- active bleeding
What is the guideline recommendation for PPI therapy?
Pantoprazole 80 mg bolus + 8 mg/hr for 72 hrs
In a UGIB, you only treat H.pylori if there are systemic symptoms. (T/F)
False: treat H.pylori if present
How is H.pylori treated?
PPI
antibiotics
Increasing gastric pH helps do what?
- promote platelet aggregation
- strengthen clot formation
- inhibit fibrinolysis
Esophageal varices are present in ___% of patients with cirrhosis.
50
Why do esophageal varices occur?
portal HTN and the development of collateral bloodflow
Varicies only arise in the esophagus. (T/F)
False: can develop anywhere in the GI tract
Where are the most common locations for varices?
esophagus
stomach
rectum
Gastroesophageal junction has the thinnest tissue layer of GI tract. (T/F)
True
What is the gold standard for diagnosis of variceal bleeding?
esophagogastroduodenoscopy (EGD)
When should treatment for suspected variceal bleed occur?
immediately
How do somatostatin analogs treat variceal bleeding?
cause splanchnic vasoconstriction : reduces blood inflow
What is the somatostatin regimen for variceal bleeding?
Octreotide 50 mcg bolus + 25-50 mcg/hr x 2-5 days
What is the PPI regimen for variceal bleeding?
none: not generally effective in variceal bleeding
You should hold beta blocker therapy in a patient with a variceal bleed. (T/F)
true
Endoscopies should be performed within __ hours of bleed.
12
What are some treatment options that are conducted via endoscope?
- sclerotherapy
- banding
- clipping
What is the TIPS procedure?
A shunting surgery that helps blood flow through the hepatic vasculature.
Balloon tamponade is used as a ________ to the TIPS procedure.
a. alternative
b. bridge
c. preparation
d. reversal
bridge
In addition to somatostatin therapy, what other therapy should be included in a cirrhotic variceal bleed?
antibiotics
Why are cirrhotic patients at risk for infection?
Low albumin (from liver damage) allows fluid to leak out of vasculature. This fluid tends to accumulate in the peritoneal cavity and is an excellent growth medium for bacteria.
What antibiotics are used in variceal bleeding?
Norfloxacin
Ceftriaxone
