Feb16 M2-GI Bleeding

Question 1

main cause of upper GI bleeding

Answer 1

peptic ulcer

Question 2

GI bleeding categories

Answer 2

overt (upper, middle, lower) or occult (don’t know cause)

Question 3

2 types of GI bleeding

Answer 3

1. liver patients with cirrhosis, varices

2. other. (the likely peptic ulcer type)

Question 4

symptoms of upper GI bleed

Answer 4

melena (note: 20% may pass red blood in stool), vomit blood, hypovolemic shock

Question 5

3 main causes of upper GI bleeding in order

Answer 5

1. gastric or duodenal ulcer
2. gastric or esophageal varices
3. erosive esophagitis (GERD, reflux)
   (4. no cause)
   (5. tumor)

Question 6

UGI bleed 3 dx things

Answer 6

1. history (aspirin, NSAIDs, liver disease, NG tube)
2. physical + vital signs
3. lab tests (CBC for Hb, platelets, *urea > Cr in GI bleed)

Question 7

initial UGIB management

Answer 7

ABC, prep transfusion, fluids, endoscopy soon. risk stratification

Question 8

2 drugs before endoscopy

Answer 8

1. PPI

2. erythromycin (prokinetic: see better + break clots)

Question 9

endoscopic THERAPY goal and when

Answer 9

stop acute bleeding and reduce risk of coming back + is for high risk

Question 10

4 endoscopic THERAPY methods

Answer 10

• injection (NE to vasoconstrict)
• thermal coagulation (burn vessel)
• mechanical compression (clips)
• hemostatic powders

Question 11

management if endoscopic therapy not working

Answer 11

• radiological percutaneous embolization and shunts (chemicals)
• surgery
• radiation

Question 12

PPIs useful in what bleeding (UGIB)

Answer 12

non variceal bleeding. blocking acid: reduce risk of rebleeding
NO PURPOSE IN PORTAL HTN

Question 13

variceal UGIB treatment 2 things

Answer 13

1. combination of meds (octreotide)

2. endoscopy (therapy)

Question 14

octreotide and sts effects

Answer 14

octreotide = somatostatin: vasoconstricts. less bleeding

Question 15

steps of endoscopic therapy (what you try) in esophageal varices

Answer 15

elastic, crazy glue, bypass, balloon in esophagus

Question 16

UGIB with bad prognosis

Answer 16

variceal. 60% rebleeding. 33% mortality

Question 17

LGIB 3 assessments for dx

Answer 17

1. history (past diverticulosis, cramps, diarrhea, pain, heart disease for ischemia)
2. physical + vital signs
3. lab tests (CBC for Hb, platelets, *urea > Cr in GI bleed)

Question 18

management of LGIB (initial)

Answer 18

resuscitation (like UGIB: fluid, check matching for transfusion). + colonoscopy

Question 19

LGIB most common cause

Answer 19

diverticulosis

Question 20

LGIB 5 most common causes

Answer 20

1. diverticulosis
2. internal hemorrhoids
3. ischemic colitis (hypotn episode)
4. rectal ulcers
5. colonic vascular lesions

Question 21

LGIB therapy and what if nothing found

Answer 21

same as UGIB (injection, thermal coag, compression, hemostatic powders)
nothing = gastroscopy and if nothing capsule endoscopy

Question 22

LGIB alternate therapies

Answer 22

• angiographic embolization

- surgery

Question 23

LGIB prognosis

Answer 23

depends on cause. usually good. 2-4% is overall mortality

Question 24

obscure (middle) GIB when to dx

Answer 24

nothing on upper and lower colonoscopy even when repeated. DX IS WITH CAPSULE ENDOSCOPY

Question 25

most common source of MGIB (middle)

Answer 25

vascular lesions

Question 26

MGIB bleeding where + what % of overt bleeding

Answer 26

5% of overt bleeding.

are in SI

Question 27

main consequence of GI bleeding

Answer 27

iron deficiency (in adult men and postmenopausal women)