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1. Internal Medicine I > 6. GI bleeding > Flashcards

6. GI bleeding Flashcards

1
Q

What are the symptoms of acute gastrointestinal hemorrhage?

A

Symptoms include
- hematemesis (fresh blood, coffee ground),
- melena,
- hematochesia,
- occult bleeding,
- anemia.

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2
Q

What is the most common cause of upper GI hemorrhage?

A

The most common cause of upper GI hemorrhage is peptic ulcer bleeding (~50%).

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3
Q

What are some causes of lower GI bleeding?

A

Causes of lower GI bleeding include
- diverticulosis,
- polyp,
- cancer,
- inflammation,
- ischemia,
- iatrogenic (polypectomy),
- vasculitis.

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4
Q

What are some symptoms of lower GI bleeding?

A

Symptoms of lower GI bleeding include anemia, melena, and hematochesia.

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5
Q

What are the possible causes of upper gastrointestinal hemorrhage?

A

Possible causes of upper gastrointestinal hemorrhage include
- variceal bleeding
- non-variceal bleeding : peptic ulcer, erosive lesions, Mallory-Weiss syndrome, cancer…

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6
Q

What are the symptoms of upper gastrointestinal hemorrhage?

A

Symptoms of upper gastrointestinal hemorrhage include
- anemia,
- melena,
- hematemesis, (+/- hematochezia)

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7
Q

What are the possible causes of peptic ulcer bleeding?

A
  • H. Pylori,
  • NSAIDs,
  • anticoagulants,
  • platelet aggregation inhibitors
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8
Q

What are the clinical features of peptic ulcer bleeding?

A

Clinical features of peptic ulcer bleeding include
- epigastric pain,
- dyspepsia,
- fatigue,
- melena,
- hematemesis
- hematochezia.

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9
Q

What are the possible laboratory tests used to assess upper gastrointestinal hemorrhage?

A
  • blood count,
  • minerals,
  • BUN,
  • creatinine,
  • prothrombin.
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10
Q

What is the recommended therapy for high-risk patients in upper gastrointestinal bleesing?

A
  1. Early or emergency upper GI endoscopy
  2. Intravenous proton pump inhibitor therapy with a bolus followed by continuous infusion if needed.
  3. Second endoscopic treatment, with radiology or surgery if needed
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11
Q

What is the recommended management for patients with cardiovascular disease who develop upper gastrointestinal bleeding?

A

Start proton pump inhibitor therapy and reinstitute antiplatelet therapy (aspirin) as soon as possible.

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12
Q

What is the Forrest classification used for?

A

It is used to classify the endoscopic appearance of bleeding ulcers.

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13
Q

What is the recommended timing for endoscopy in stable, mild to moderate risk patients with upper gastrointestinal bleeding?

A

Early endoscopy (<24h).

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14
Q

What is the recommended timing for endoscopy in high-risk, unstable patients with upper gastrointestinal bleeding despite resuscitation?

A

Emergency endoscopy (<12h).

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15
Q

What is the recommended treatment for active bleeding ulcers (Forrest classification Ia or Ib)?

A

Combination of epinephrine injection with a second hemostasis modality (contact thermal, mechanical therapy, or injection of a sclerosing agent).

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16
Q

What is the recommended treatment for non-bleeding visible vessel ulcers (Forrest classification IIa)?

A
  • Mechanical therapy (hemoclip),
  • thermal therapy (coagulation),
  • injection of a sclerosing agent as monotherapy / in combination with epinephrine injection.
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17
Q

What is the recommended treatment for adherent clot ulcers (Forrest classification IIb)?

A

Endoscopic clot removal should be considered.

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18
Q

What is the mechanism of action of epinephrine injection in the treatment of bleeding ulcers?

A

It causes vasoconstriction and reduces blood flow to the bleeding site.

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19
Q

What should be done for any identified underlying active bleeding (Forrest Ia., Ib.) or non-bleeding visible vessel (Forrest IIa.) during endoscopy?

A

It should receive endoscopic hemostasis.

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20
Q

What is the Glasgow-Blatchford Score?

A

It is a scoring system used to predict the need for medical intervention in patients with upper gastrointestinal bleeding.

21
Q

What is the purpose of the rapid urease test during endoscopy?

A

It is used to detect the presence of Helicobacter pylori bacteria in the stomach lining.

22
Q

What is the incidence of variceal bleeding in all upper GI bleedings?

A

5-20%.

23
Q

What is the mortality rate of variceal bleeding?

A

~20%.

24
Q

What is the etiology of variceal bleeding?

A

Portal hypertension (pre-sinusoidal, sinusoidal, post-sinusoidal).

25
Q

What are the signs of variceal bleeding?

A

Epigastric discomfort, dyspepsia, fatigue.

26
Q

What are the symptoms of variceal bleeding?

A
  • Hematemesis,
  • melena-haematochezia,
  • anemia,
  • hypovolemia,
  • signs of chronic liver disease.
27
Q

What examinations are done to diagnose variceal bleeding?

A
  • Physical state,
  • laboratory : blood-count, electrolytes, liver function test, prothrombin, BUN, creatinine.
28
Q

What is the vasoactive therapy for variceal bleeding?

A
  • terlipressin (IV - 2mg)
  • octreotide (IV)
  • somatostatin (IV)
29
Q

What is the guideline for managing variceal bleeding?

A

Endoscopic ligation

30
Q

When should prothrombin complex concentrate be administered for variceal bleeding?

A

For active bleeders taking vitamin K antagonist.

31
Q

What is the recommended for cirrhotic patients with suspected upper GI bleeding?

A

Antibiotic prophylaxis : oral or IV quinolone, or 3rd generation cephalosporin IV for 5-7 days.

32
Q

What is the recommended pre-endoscopy infusion for upper GI bleeding?

A

Erythromycin (250mg IV 30-120 min before).

33
Q

What is the effect of terlipressin on variceal pressure?

A

Rapid decrease of variceal pressure after a couple of minutes

34
Q

What should be done if endoscopic therapy fails to control bleeding?

A

Balloon tamponade should be performed to temporarily control bleeding until more definitive therapy.

35
Q

What is the maximum duration for which balloon tamponade should be maintained?

A

Balloon tamponade should not be maintained for more than 24 hours.

36
Q

What is the recommended time frame for TIPS in cases of refractory variceal bleeding?

A

Emergency (<24 hours) or early (<72 hours) for therapeutic success.

37
Q

What may be considered in cases of refractory variceal bleeding?

A

The use of self-expandable covered metal stents (SEMS) may be considered.

38
Q

What is the surgical treatment for refractory variceal bleeding?

A
  • Porto-caval anastomosis
  • self expanding metal stents may be considered
39
Q

What is the purpose of endoscopic variceal ligation (EVL)?

A
  • secondary prophylaxis of rebleeding
  • may be used in primary prophylaxis (M/L varices).
40
Q

What are the risk factors for lower GI bleeding?

A
  • Anticoagulants,
  • NSAID,
  • comorbidity.
41
Q

What are the signs of lower GI bleeding?

A
  • Discomfort,
  • pain,
  • fatigue.
42
Q

What are the symptoms of lower GI bleeding?

A
  • Melena,
  • hematochesia,
  • anemia (collapse).
43
Q

What are the etiologies of lower GI bleeding?

A
  • Diverticulosis,
  • ischemic colitis,
  • angiectasia,
  • hemorrhoids,
  • polyps/neoplasia,
  • iatrogenic (polypectomy, dilatation),
  • IBD,
  • infectious colitis,
  • vasculitis.
44
Q

What are the guidelines for lower GI bleeding management?

A
  • Colonoscopy,
  • endoscopic hematostasis (in case of high risk of bleeding)
45
Q

What is small bowel bleeding?

A

Bleeding that occurs in the jejunum or ileum, which are parts of the small intestine.

46
Q

What is the first-line procedure for diagnosing small bowel bleeding?

A
  • Excluding upper and lower GI bleeding first
  • Video capsule endoscopy (VCE)
  • Deep enteroscopy
47
Q

What is the advantage of CT enterography in diagnosing small bowel bleeding?

A

CT enterography has the advantage of locating masses.

48
Q

What is Hemospray powder?

A

Hemospray powder is a highly adsorptive powder that becomes cohesive and forms a stable mechanical plug.

49
Q

What is endoscopic suturing?

A

Endoscopic suturing is arguably the most secure form of hemostasis.

1. Internal Medicine I (20 decks)

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