Chapter 39: Upper Gi Bleeding Flashcards
what is it
bleeding into the lumen of the proximal git ie proximal to the ligament of trietz
what are the signs and symptoms
- Hematemesis
- melena
- syncope
- shock
- fatigue
- coffee-ground emesis
- hematochezia
- epigastric discomfort,
- epigastric tenderness
- signs of hypovolemia
- guaiac-positive stools
Why is it possible to have hematochezia?
Blood is a cathartic, and hematochezia usually indicates a vigorous rate of bleeding from the UGI source
Are stools melenic or melanotic?
Melenic (melanotic is incorrect)
What is the most common cause of significant UGI bleeding?
PUD—duodenal and gastric ulcers (50%)
What is the common differential diagnosis of UGI bleeding?
- Acute gastritis
- Duodenal ulcer
- Esophageal varices
- Gastric ulcer
- Esophageal
- Mallory–Weiss tear
What is the diagnostic test of choice with UGI bleeding?
EGD (>95% diagnosis rate)
What are the treatment options with the endoscope during an EGD?
- Coagulation
- injection of epinephrine (for vasoconstriction)
- injection ofsclerosing agents (varices)
- variceal ligation (banding)
Which lab tests should be performed?
- Chem-7
- bilirubin
- LFTs
- CBC
- type and cross
- PT/PTT
- amylase
Why is BUN elevated?
Because of absorption of blood by the GI tract
What is the initial treatment?
- IVFs (16 G or larger peripheral IVS × 2), Foley catheter (monitor fluid status)
- NGT suction (determine rate and amount of blood)
- Water lavage (use warm H2O—will remove clots)
4. EGD: endoscopy (determine etiology/location of bleeding and possible treatment—coagulate bleeders)
Why irrigate in an upper GI (UGI) bleed?
To remove the blood clot so you can see the mucosa
What test may help identify the site of MASSIVE UGI bleeding when
EGD fails to diagnose cause and blood continues per NGT?
Selective mesenteric angiography
What are the indications for surgical intervention in UGI bleeding?
- Refractory or recurrent bleeding and site known
- >3 unit PRBCs to stabilize or >6 unit PRBCs overall
What percentage of patients require surgery?
≈10%