Chapter 39: Upper Gi Bleeding Flashcards

1
Q

what is it

A

bleeding into the lumen of the proximal git ie proximal to the ligament of trietz

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2
Q

what are the signs and symptoms

A
  1. Hematemesis
  2. melena
  3. syncope
  4. shock
  5. fatigue
  6. coffee-ground emesis
  7. hematochezia
  8. epigastric discomfort,
  9. epigastric tenderness
  10. signs of hypovolemia
  11. guaiac-positive stools
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3
Q

Why is it possible to have hematochezia?

A

Blood is a cathartic, and hematochezia usually indicates a vigorous rate of bleeding from the UGI source

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4
Q

Are stools melenic or melanotic?

A

Melenic (melanotic is incorrect)

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5
Q

What is the most common cause of significant UGI bleeding?

A

PUD—duodenal and gastric ulcers (50%)

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6
Q

What is the common differential diagnosis of UGI bleeding?

A
  1. Acute gastritis
  2. Duodenal ulcer
  3. Esophageal varices
  4. Gastric ulcer
  5. Esophageal
  6. Mallory–Weiss tear
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7
Q

What is the diagnostic test of choice with UGI bleeding?

A

EGD (>95% diagnosis rate)

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8
Q

What are the treatment options with the endoscope during an EGD?

A
  1. Coagulation
  2. injection of epinephrine (for vasoconstriction)
  3. injection ofsclerosing agents (varices)
  4. variceal ligation (banding)
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9
Q

Which lab tests should be performed?

A
  1. Chem-7
  2. bilirubin
  3. LFTs
  4. CBC
  5. type and cross
  6. PT/PTT
  7. amylase
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10
Q

Why is BUN elevated?

A

Because of absorption of blood by the GI tract

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11
Q

What is the initial treatment?

A
  1. IVFs (16 G or larger peripheral IVS × 2), Foley catheter (monitor fluid status)
  2. NGT suction (determine rate and amount of blood)
  3. Water lavage (use warm H2O—will remove clots)
    4. EGD: endoscopy (determine etiology/location of bleeding and possible treatment—coagulate bleeders)
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12
Q

Why irrigate in an upper GI (UGI) bleed?

A

To remove the blood clot so you can see the mucosa

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13
Q

What test may help identify the site of MASSIVE UGI bleeding when
EGD fails to diagnose cause and blood continues per NGT?

A

Selective mesenteric angiography

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14
Q

What are the indications for surgical intervention in UGI bleeding?

A
  1. Refractory or recurrent bleeding and site known
  2. >3 unit PRBCs to stabilize or >6 unit PRBCs overall
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15
Q

What percentage of patients require surgery?

A

≈10%

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16
Q

What percentage of patients spontaneously stop bleeding?

A

≈80% to 85%

17
Q

What is the mortality of acute UGI bleeding?

A

Overall 10%, age 60 to 80 years 15%, age >80 years 25%

18
Q

What are the risk factors for death following UGI bleed?

A
  1. Age >60 years
  2. Shock
  3. >5 units of PRBC transfusion
  4. Concomitant health problems
19
Q
A