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Gastrointestinal System > EXAM #2: GI BLEEDING > Flashcards

EXAM #2: GI BLEEDING Flashcards

1
Q

What delineates between upper and lower GI bleeding?

A

Trietz angle

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2
Q

What does occult bleeding indicate?

A

Slow bleeding/ low volume

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3
Q

What is melena and indication of?

A

UGI bleed

  • Esophagus
  • Stomach
  • Duodenum
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4
Q

What is hematochezia?

A

Dark red blood or dark maroon colored blood

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5
Q

What does hematochezia indicate?

A
  • Usually lower GI bleed

- Potentially v. fast UGI

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6
Q

What do you need to remember about stool color?

A

DO NOT USE STOOL COLOR TO R/O ORIGIN

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7
Q

What is the typical manifestation of chronic GI bleeding?

A

Anemia

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8
Q

What is the typical presentation of acute GI bleeding?

A

Signs and symptoms of volume loss

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9
Q

How much does the blood pressure need to drop when changing positions for positive orthostatic changes?

A

20 mm/Hg (systolic), also:

  • 10 mm/Hg diastolic
  • HR increase 10 bpm
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10
Q

What change will be heard with bowel sounds in a UGI?

A

Increased bowel sounds–blood is an irritant

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11
Q

Review the first case study in the ppt. How sick is the patient? Why?

A

V. sick

  • Hx of HTN and hypotensive
  • Beta blocker and tachycardia
  • Orthostatic changes

Significant hypovolemia*

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12
Q

What is the DDx of a UGI?

A

1) PUD
2) Erosive esophagitis/ gastritis/ duodenitis i.e. NSAIDs or H. pylori
3) Gastroesophageal varices

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13
Q

What is GAVE?

A

Gastric antral vascular ectasia

- Dilated small vessels in the antrum of the stomach

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14
Q

What is the buzzword associated with GAVE?

A

Watermelon Stomach

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15
Q

What is a cause of UGI that is associated with very high mortality?

A

Aortoenteric fistula

  • Abnormal connection between aorta and intestines
  • Typically occurs secondary to AAA repair
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16
Q

What is a Dieulafoy lesion?

A
  • Abnormal arterial GI vessel
  • V. superficial
  • Life-threatening bleeding results
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17
Q

What is the most common etiology of lower GI bleed, especially in the elderly?

A

Diverticulosis

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18
Q

List the three most common causes of Lower GI Bleed.

A

1) Diverticulosis
2) Angiectasias
3) Hemorrhoids

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19
Q

What two diseases increase the rate of Angiectasias?

A

1) AAA

2) Renal failure

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20
Q

What is Osler-Weber Rendu?

A

Genetic disorder that causes diffuse vascular dysplasia

  • Increases the risk for bleeding
  • Also known as Hereditary Hemorrhagic Telangectasia (HHT)
  • Autosomal dominant inheritance
21
Q

What two diseases can cause hyperpigmentation of the oral mucosa that can predispose one to GI bleeding?

A

1) Osler-Weber Rendu/ HHT

2) Peutz-Jeghers Syndrome

22
Q

What must be performed during the PE if you suspect volume loss in a patient?

A

Orthostatic vital signs

23
Q

What are the predictors of UGI?

A

1) Less than 50 y/o
2) Melenic stool
3) BUN/Creatinine ratio greater than 30

24
Q

What are the indications for an NG tube in the face of GI Bleeding?

A

1) Hematemesis
2) Frank hematochezia

Note that 15-20% of patients with upper GI bleeding will have a negative NG aspirate–keep in differential even if negative.

25
Q

How do you begin the resuscitation of a patient with significant hypovolemia?

A

1) IV access (bilateral large bore)
2) Crystalloids
3) Anticipate need for blood transfusion

26
Q

When do you need to transfuse a patient with a GI bleed?

A

Hgb less than or equal to 7 g/dL

27
Q

What is AIMS65? What is it used for?

A

Risk score that predicts mortality, length of stay, and cost

  • Albumin less than 3
  • INR greater than 1.5
  • AMS
  • Systolic less than 90 mm/Hg
  • 65+ y/o
28
Q

What is the Rockall Scoring System?

A

Predictor of mortality in UGIB

29
Q

What is the utility of the Blatchford Score?

A

This score predicts the NEED for ENDOSCOPIC THERAPY

30
Q

Once you have resuscitated a patient with a non-variceal UGIB, how can you start pharmoctherapy?

A

IV PPI

  • Facilitates clot formation
  • stop once diagnostic endoscopy has been performed
31
Q

What procedure is always indicated for patients with a suspected UGIB?

A

Endoscopy (within 24 hours)

32
Q

What is the purpose of endoscopoy?

A

1) Confirmation of diagnosis
2) Risk stratification
3) Speeds access to therapy

33
Q

When is endoscopic therapy required? What determines this requirement?

A

Stigmata i.e. characteristics:

1) Active bleeding
2) Nonbleeding visible vessel

Treating these is done to prevent rebleeding*

34
Q

What are the stigmata that don’t require endoscopic therapy?

A

1) Adherent clot
2) Flat pigmented spot
3) Clean base

35
Q

How is hemostasis achieved with endoscopy?

A

1) Epi injection
2) Electrocoagulation
3) Clipping (mechanical)

Often combination therapy is employed.

36
Q

In a patient with CAD that is on ASA, when should ASA be re-started following a UGIB?

A

As soon as the bleeding as been resolved

37
Q

What is the mnemonic for remembering the clinical features of variceal bleeding?

A

1/3

  • Occurs in 1/3 of patients with cirrhosis
  • 1/3 are initially fatal
  • 1/3 rebleed in 6 weeks
  • 1/3 survive a year
38
Q

What is the mnemonic to remember how to manage variceal bleeding?

A

VARICEALB

V= Vasoconstrictor 
A= Antibiotics 
R= Resuscitation 
IC= ICU level care 
E= Endoscopy 
AL= Alternative 
B= Beta blockers
39
Q

What is the common vasoconstrictor used to treat Variceal bleeding?

A

Terlipressin

40
Q

Why are ABX used in Variceal bleeding?

A
  • Reduce infection

- Reduces rebleeding

41
Q

When should endoscopy be performed in variceal bleeding?

A

ASAP after resuscitation

42
Q

What is the “alternative” rescue technique used to treat variceal bleeding?

A

TIPS

Transjugular Intrahepatic Portosystemic Shunt

43
Q

What type of beta-blocker should be used to treat Variceal bleeding?

A

Nonselective

44
Q

What are the predictors of severe LGIB?

A

1) HR greater than 100
2) SBP less than 115
3) Syncope
4) Nontender abdominal exam
5) 2+ comorbid conditions

45
Q

What are the three major risk factors for mortality in LGIB?

A

1) Age
2) Intestinal ischemia
3) Comorbid illness

46
Q

What do you do a colonoscopy in LGIB?

A

Unlike UGIB, urgent colonscopy is NOT required

47
Q

What is the alternative study to a colonscopy in a LGIB?

A

Angiography

Note that the advantage of this is that IR can coil this and provide definitive treatment.

48
Q

When is surgery required for LGIB?

A

1) SEVERE bleeding

- Requires more than 6 units of blood

49
Q

What procedure is indicated in obscure GI bleeding?

A

Capsule endoscopy

Gastrointestinal System (42 decks)

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