Evaluation of GI bleeding Flashcards
what are the most common upper GI bleed ddx?
PUD
erosive esophagitis / gastritis / duodenitis
gastroesophageal varices
aortoenteric fistula
what is dieulafoy’s lesion? where does it usually present?
large tortuous arteriole in the stomach wall (sub mucosal) that erodes and bleeds
upper GI
what is the main ddx for lower GI bleed?
diverticulosis
which conditions increase the rate of telangiectasias?
aortic valvular disease
chronic renal failure
what is osler-weber rendu?
perioral petichiae
what are predictors of upper GI source?
age under 50
melenic stool
BUN / creatinine ratio over 30
when is an NG tube used?
when patient is vomiting blood
what must remain in the ddx in patients with severe hematochezia, even in NG aspirate is negative?
upper GI bleed
what type of fluids should be used first in large volume GI blood loss?
crystalloids
what is the Hb threshold for transfusion?
less than or equal to 7 g/dL
what does the AIMS65 score predict? what are the parameters?
predicts in-hospital mortality, LOS, cost in patients with upper GI bleed
Albumin less than 3 INR over 1.5 Mental status altered Systolic BP less than 90 65 yo or older
what does the Rockall scoring system predict? what are the components? what are the parameters?
validated predictor of mortality in patients with upper GI
bleed
clinical and endoscopic
age, shock, comorbidity
what does the Blatchford score predict? what is it useful for?
predicts need for endoscopic therapy
safe discrimination of low risk UGIB patients who will likely NOT require endoscopic hemostasis
what is the pre-endoscopic therapy for non-variceal UGIB? why?
IV PPIs
downstages lesion
what therapy is recommended for most patients with acute UGIB? when must it be done?
endoscopy
within 24 hours
what is the endoscopic hemostasis therapy?
EPI injection
thermal electrocoagulation
mechanical - hemoclips
what are the predictors of large esophageal varices?
severity of liver disease (child pugh)
platelet count less than 88k
palpable spleen
what is the main vasoconstrictor agent for variceal bleed?
octreotide
what is the goal of vasoconstrictor therapy?
reduce splanchnic blood flow
what reduces the incidence of bacterial infection and significantly reduces early rebleeding?
prophylaxis abx
what is TIPS? what is it used for?
transjugular intrahepatic portosystemic shunt
treatment of gastric variceal bleeding
what is the result of beta blockers for GI bleeding? which type of beta blocker should be used?
reduces risk for recurrent variceal hemorrhage
nonselective (eg nadolol)
what is the main cause of lower GI bleed? how does it present?
diverticulosis
large volume, painless
how does colitis lower GI bleed present?
smaller volume
pain
diarrhea
what are the risk factors for mortality in LGIB?
age
intestinal ischemia
comorbid illnesses
what is the recommended test for patients with brisk bleeding who cannot be stabilized or prepped for colonoscopy?
angiography
when is CT angiogram indicated?
active bleeding but hemodynamically stable
what is the indication for capsule endoscopy?
obscure GI bleed
what two factors are critical to reduce mortality from UGIB?
early resuscitation
supportive measures
what are the most common causes of chronic lower GI bleed?
neoplasm
angiectasia
IBD
