Chapter 89 Gastrointestinal Emergencies - Incomplete Flashcards
True or false - the hematocrit is an unreliable index of acute blood loss ( in the case of Gi bleed)
True - it may be normal or slightly decreased
When should colloidal solutions such as albumin, plasma or hetastarch be used with GI bleed?
Massive continuous blood loss - because in this solution there is risk of shock lung and a loss in plasama oncotic pressure
Why is dextran avoided in fluid resuscitation
Can affect platelet function
Why are PRBCs better than whole volume blood
Less ammonia, less volume
Complications of massive transfusions
Hypercitrinemia , hyperlacticacidemia, hypocalcemia, decreased clotting factors and thrombocytopenia
What should you give anyone with Gi bleeding whohas low PT regardless of liver function
5-10 mg vitamin K (subq for non life threatening, IV for life threatening)
In what cases should specific causes of an upper GI bleed be found
Active bleeding as documented by NG lavage,
Evidence of severe hemorrhage ( documented Hb <10)
Conditions affecting healing/ clotting e.g. catabolic state or serious chronic disease
Hx of unexplaiend gorss occult bleeding or Fe deficiency anemia
Hx of chronic dyspepsia
What is the purpose of gastric lavage?
Confirm level of bleeding and estimate the rate of upper Gi bleed
True or false gastric lavage can control GI hemorrhage
False - no evidence to suggest this andif clear this does not exclude a major bleeding cause
What should you use to lavage in children
NG sump tube (12 F in small children,m 14- 16 F in older)
When there is bright red blood that does not clear with repeated gastric lavage for 5-10 minutes - what does this suggest
Significant or on-going hemorrhage
How common is clinically apparent UGI bleeding due to esophageal, gastric and duodenal ulcerations in full term newborns
1% healthy full term newborns
true or false MW tears are rare in children
True
In what circumstances should baloon tamponade be performed
When patient is unrepsive the pharmacotheraoy ir cannot have EGD in timely fashion
True of false the Sengstaken-Blackmore tube has one balloon compared to a Linton tube which has two
False - S-B tube has both gastric and esophageal baloons, Linton only has single lavage gastric tube
Major complication risk from S-B tube tamponade
What about death risk?
9-35% - major complication risk
5-20% mortality rate
What test can help identify swallowed maternal blood in newborn - how does it work ?
Apt-Downey test - blood from aspirate is placed on filter paper and mixed with 1% NaOH - adult Hb will be reduced to give rusty brown color - fetal Hb will not denature and remain red or pink
Massive hematemesis usually without any prodromal symptoms
Dielafoy lesion - due to pinpoint non-ulcerated arterial lesion - usually high in the fundis of the stomach - often due to submucosal artery that has taken a tortuous course and eroded through a mucosal defect
True or flase - anal fissures can result due to diarrhea and constipation
True - diarrhea can cause irritation
Constipation is the most common cause
