Clincal Disorders-GI Bleeding Flashcards
For a patient admitted to the ICU, what should immediately be places
Two large bore (18 gauge or larger) IV lines
What is given to patients with a bleeding varices
FFP/platelets
Vitamin K IV
What are the most common caused of acute lower GI bleed in patients under 40
Neoplasms, Crohn’s disease, celiac, and Meckels
What is the method of diagnosis for an acute lower GI bleed
Colonoscopy
If hypertension is present with a ulcer proliferation, which other conditions need to be looked at
- Ruptured aortic aneurysms
- Mesenteric infarction
- Acute pancreatitis
Which side is more common for ovarian torsion
Right side because of increased length of utero-ovarian ligament, with the left having the sigmoid colon present to restrict movement
What are the factors that can increase the risk for an ectopic pregnancy
History of infertility, PID, ruptured appendix, and tubal surgery
What is the most common cause of lower GI bleeds
Diverticulosis
What is the treatment for someone with ulcer perforation
- Laproscopic perforation closure
- Nasogastic suction, PPI, broad spectrum antibiotics
What drugs are given to patients with a bleeding varices
Third gen cephalosporin
Fluoroquinolones
-Somatostatin and octreotide (vasoconstrictors)
What is a dieulafoy lesion
Large caliber submucosal artery
What is gastric outlet syndrome
Edmena or narrowing of the pyloric or duodenal bulb, commonly now seen with an intraabdominal neoplasm
What are the characteristics of symptoms for ischemic colitis
Crappy abdominal pain, followed by bloody diarrhea
What is the telangiectasias
Small cherry red lesions cause by dilation of venules
What are some of the things that can bring on ischemia colitis
-Long distance running, vasculitis, CAD, estrogen therapy
What is the diagnosis for liver penetration
Endoscopy confirms ulceration and abdominal CT shows penetration
What is occult GI bleeding
Bleeding in the feces that is no apparent to the patient
What age group of boys typically presents with the testicular torsion
12-18
In the case of ulcer proliferation, what are present for the diagnosis
Leukocytosis
Mild elevation of amylase
Abdominal CT
What conditions are seen to have large numbers of telangiectasias
Hereditary hemorrhagic telangiectasia aka Osler Weber Rendu or CREST
What is the most common cause of maternal death during the first trimester
Undetected ectopic pregnancy
What is the treatment for a patient with an upper GI bleed
IV or oral PPI
Octreotide (reduces blood flow)
In patients with iron deficiency anemia should be evaluated for which possible conditions
Celiac disease with a IgA anti-TTG or biopsy
What is given to patients with history of bleeding varices in order lower risk of rebleeding
Beta blockers
What does black stools, aka melana indicative of with regards to the location of the bleed
Proximal to the ligament of the trietz
What is the diagnostic approach to GI hemorrhage
Endoscopy (EGD)
Which form of ulcer penetration is the worse
Posterior because it goes into the pancreas, liver, and biliary tree
What is the most reliable method of detection and treatment of Meckels diverticulum
- Detection: technetium 99 scan
- Treatment: surgical resection
What are the conditions that commonly are assocaited with Toxic megacolon
- UC
- C. Difficile
- Chagas
- Oglivie
What is the location of an acute lower GI bleed
-Distal to the ligament of Treitz
What is the common symptom seen for a GI hemorrhage
“Coffee ground” emesis
What si the treatment for acute mesenteric ischemia
Laparotomy
What is the most common associated finding with ovarian torsion
-ovary greater that 4 cm due to a cyst, tumor, edema
What is antioectesias
Aberrant submucosal Vessels caused by chronic blockage of veins, usually in the right colon
What are the most common causes of lower Gi bleeds in patients over the age of 50
Diverticulosis, angectasias, malignancy, or ischemia
Which preexsting conditions will predispose a patient to diverticulosis
Marfans, Ehlers-Danilo’s, scleroderma
How is occult GI bleeding identified
- positive fecal occult blood test (FOBT)
- fecal immuno Chemical test (FIT)
- Iron deficiency due to the bleeding
Which patients are angiodysplasias seen
Over 70 with chronic renal failure
What are the symptoms of an ulcer penetration
More diffuse pain since the pancreas is now involved, unresponsive to antacids
What are the drugs that increase the risk factors for lower GI bleed
ASA, nonASA antiplatlets, NSAIDs
What is the primary method of diagnosis for ovarian torsion
Transvaginal Ultrasound with Doppler
What are the symptoms of vascular disorders of the small and large intestine
- Extremely painful, but the abdominal exam will be fairly normal, may look like they are faking
- Fear of food
- Thumbprinting on scan
What is the prognosis of diverticulosis bleeding
Usually the ascending colon and is self limiting
What are the risk factors for bleeding from esophageal varices
-Size
-presence of red wale markings (longitudinal dilated venules on the surface)
-Severity of the liver disease
Active alcohol abuse
What should be done for all patients with UGIB and what are the benefits
Upper endoscopy because:
- Find source of bleed
- Find risk of rebleeding and guiding triage
- Render endoscopic therapy
What is the diagnostic method of choice of an acute mesenteric ischemia
CT angiography
