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)
