Gastro hemorrhage

Question 1

Typical sx

Pts w hematemesis/coffee ground emesis/melena considered to have

hematochezia

Answer 1

Hematemsis (bright red/maroon), coffe ground emesis, melena (black/tar stools), hematochezia (bright red/maroon stool)

bleeding prox to LoT

distal to LoT

Question 2

Occult bleeding

acute brisk bleeds

Hb does not fall bc

w extravascular fluid enters to restore volume

Answer 2

wout overt sx (may see anemia/syncope/light headed)

change in vitals

proportional loss plasma, RBC

normocytic anemia

Question 3

Class 1
Class 2
Class 3
Class 4

Blood loss
% vol
Pulse
BP
Resp

Answer 3

<750, <15, <100, Norm x2

750-1000, 15-30, 100-120, ortho, 20-30

1500-2000, 30-40, 120-140, dec, 30-40

> 2000, >40, >140, dec, >35

Question 4

Orthostasis

Chronic bleed best judged by

Vitals usually

Upper GI bleeding

Answer 4

dec SBP/pulse >20 when standing

Anemia- micro from Fe loss

Normal

inc BUN/creat- absorped blood products, more profound bleeding/IV vol depletion

Question 5

MCC upper GI hemorrhage

presentaton

as they penetrate MM

Answer 5

PUD- NSAID/H pylori assc

epigastric pain/tenderness

erodes GD arteries or L gastric artery- brisk hemorrhae

Question 6

2nd MCC upper GI hem

results from

arterial bleeding

Answer 6

Gastritis- ulcers are diffuse/subepithelial

NSAID, alcohol, stress (trauma, burns, surgery, ventilation)

unlikely

Question 7

3rd MCC upper GI hem

assc dz

RF

most terminate

very high

Answer 7

Gastroesophageal varices- portal HTN

CLD, viral hep, ALD/NALD

IV drugs, alcohol, met syndrome

spontaneously, others w intervention

mortality

Question 8

MW tears

can extend to

presentatin

Answer 8

superficial tear at GE jxn

venous/arterial plexus

retching/vomiting (bright red/coffee)

Question 9

Erosive duodenitis

gastric adenocarc

aortoenteric fistula

HHT

Answer 9

NSAIDs

neopastic, identical to PUD

result of surgery, herald bleeding, severe GI hem

AD, AVM w telangectassias, painless GI hem

Question 10

Signs of upper GI hemorrhage 1st step

suspected variceal hemorrhage medication

prophylacis

Answer 10

give PPI- gastric acid damages mucosa & inhibits coag cascade

Octreotide- splanchin VC, dec bleeding

AB for SBP

Question 11

Test for hematemesis/melena

hemodynamic instability/suspected variceal hem

high risk of rebleed needs

clean ulcers/ MW/gastritis

Answer 11

upper endo

endoscopy

endoscopic hemostatic therapy

no further mx

Question 12

Ulcers and bleeding/visible vessels

procedure

continue

Answer 12

hospitalized, observed

endoscopic hemostasis, EPI, clips

PPI

Question 13

Alternatives for unstable pt

Angiography

allows ofr

Answer 13

Rn imaging (radiolabled RBC to localize bleeding, direct therapy)

intervention if localized, massive bleeding (unstable, failed others)

transcatheter embolization

Question 14

Lower GI hemorrhage characterized by

intestinal bleeds more

Left side vs right side

Answer 14

hematochezia- colon bleeding

obscure GI hem

Bright red/mroon

Question 15

MCC hematochezia

hemorrhoids are

low gade bleeding

Answer 15

hemorrhoids- self lim

dilated submucosal blleds in anus- above (in) below (ext) dentate line

blood coaing stool/dripping into toilet bowl

Question 16

Significant bleeding & hospitalization mcc

angiodysplasias

Infectious colitis

Ischemic colitis pt

precipitated by

bleedign area

presentation

Answer 16

Diverticulosis- bright red/maroon colored

dilated, tortuous submucosal vessles- bleed from veins/small volume

Camp, salm, shig

older adult, athero dz

hypoTN, shock, arrhy

anastomosis (splenic flexure, sigmoid/des colon)

ab pain, small bleed- necrosis/friability

Question 17

UC presntation

CD presentation

Colon cancer

Meckel Diverticulum

Answer 17

hematochezia, tenesmus

fever, wl, watery diarrhea

uncommon, occult bleeding

hematochezia- incomp obliterated omphalmomesenteric duct- maroon colored stools

Question 18

Lower GI bleeding presentation is usually w out

Procedure of choice

Going further

Answer 18

hemodynamic instab

colonoscopy

upper endoscopy

Question 19

Alternative to endoscopy

Answer 19

RN imaging/angiography (same as Upper)

Question 20

Obscure GI hem

source

causes

less common

Answer 20

symptoms of blood loss but neg UE/colonoscopy

SI (J/I)

tumors, erosions/ulcers (NSAIDS)

gastric erosion, angiodysplasia, ectasia

Question 21

Evaluation of Obscure Gi hem

comps

another alternative

can do

cant do

Answer 21

wireless capsule endoscopy- view entire GI tract

intervention not possible

push enteroscopy- view duodenum/jejunum

biopsy/interv

not entire jejenum/ileum