Gastrointestinal Bleeding Flashcards
most common cause of upper GI bleeding
ulcer disease, but it can also be
caused by: gastritis, esophagitis, duodenitis, cancer, and varices.
most common cause of lower GI bleeding
diverticulosis.
but then,
Angiodysplasia (arteriovenous malformation, or AVM)
Polyps or cancer
Inflammatory bowel disease
Hemorrhoids
Upper GI bleeding with rapid transit from high volume
most important initial management
for GI bleeding.
Assessing blood pressure
Ischemic Colitis CxFx and endoscopy result
left lower quadrant pain, mucosal friability
on scope, and a clear demarcation between ischemic and normal tissue.
Orthostasis is defined as:
More than a 10-point rise in pulse when going from lying down to sitting or
standing up
or
Systolic blood pressure drop of 20 points or more when sitting up
Percentage of blood loss in these Physical findings
Orthostasis
Pulse >100 per minute
Systolic BP <100 mm Hg
15%–20%
30%
30%
Variceal Bleeding Cx Fx
Vomiting blood +/– black stool Spider angiomata and caput medusa Splenomegaly Palmar erythema Asterixis
Variceal Bleeding . First measures, lab work up. Dx
severe bleeding-> first replace fluids. Check hematocrit PLT and coagulation test: PT or INR..
NG tube + aspiration?
BUT If upper endoscopy will be done
anyway, there is a limited role for an
NG tube.
Indication for Nuclear
bleeding
scan
Endoscopy unrevealing in a massive acute hemorrhage; lacks
accuracy
Indication for Angiography
Specific vessel or site of bleeding needs to be identified prior to
surgery or embolization of the vessel; used only in massive,
nonresponsive bleeding
Indication for Capsule
endoscopy
Small bowel bleeding; upper and lower endoscopy do not show
the etiology
Indication for CT or MRI
of abdomen
Not useful in GI bleeding
Indication for EKG, lactate level
Shows ischemia in severe bleeding
Gastrointestinal Bleeding Tx
1.- Fluid replacement 1-2L/h
later endoscopy
IV PPI for upper GI bleeding
when to do transfusion
2.- Packed red blood cells if the hematocrit is below 30 in those who are older or suffer from coronary artery disease; NOT in young unless HCT <25
when to give Fresh frozen plasma
if the PT or INR is elevated and active bleeding is occurring
when to give platelets
if below 50,000 + bleeding
or only if <10-20k
variceal bleeding TX
Octreotide (somatostatin) then Endoscopy banding.
if that fails -> TIPS. Transjugular intrahepatic portosystemic shunting
Tx if all fails
Qx
Esophageal and Gastric Varices next step after bleed control
Propranolol or nadolol is used to prevent subsequent episodes
Antibiotics to prevent SBP (peritonitis) with ascites
Sclerotherapy is
never the right answer if banding is technically possible
dieulafoy’s lesion. what is it?
nornal anatomic variant that can cause upper GI bleeding. Tortuous arteriola that can be anywhere on the GIT tho is more frequent in gastric wall
TIPS stands for
Transjugular intrahepatic portosystemic shunt
Boerhaave Sx patho
not a GI bleed but compared to them, transmural tear of esophagus,
Boerhaave Sx epidem
whereas mallory weiss es de los weekend warriors, BHSx es de chronic vomiters: anorexia, alcoholics
Boerhaave Sx cx fx
febrile, dyspnea, air in the mediastinum that u can hear on xray or subcutaneous, “rice krispies under skin” hamman crunch with each heartbeat
Boerhaave Sx dx
first test gastro grafin
then barium, tho gastrografin is less irritating so try to only use gg.
both normal? EGD
Boerhaave Sx tx
qx
dieulafoy’s lesion patho
normal anatomic variant
artery very close to the mucosal surface so any erosion makes it bleed
dieulafoy’s lesion cx fx
painless bleed.
dieulafoy’s lesion dx and tx
egd and resection
hemorrhoids tx
sits baths, preparation H, hemorrhoidectomy
mesenteric ischemia epidem
vasculopath pt, Afib hx or recent angiography
mesenteric ischemia cx fx
pain out of proportion of the physical exam
pain right after eating
weight loss
mesenteric ischemia dx
angiogram . don’ wait till it bleeds coño.
mesenteric ischemia tx
resect death tissue or revascularize
ichemic colitis patho
occurs at the watershed areas while hypotensive for any reason the ischemia starts
ichemic colitis dx
colonoscopy: shows death tissue
AVMs (arteriovenous malformation) are asoc with
aortic stenosis
peritonitis important signs
Cullen sign umbilliCULLES
Turner sign youTURNintoyarside
they are signs of retroperitoneal hematoma.
early complications of pancreatitis
ARDS
Hypocal
pleural effusion
dx and tx of ARDS Hypocal pleural effusion ascites
xray- intub Ca level-give ca pe. xray- ascitys: US in pancreatitis dont tube or drain both of these unless u think it's infected
midterm complications of pancreatitis
sepsis at day 6
dx with culture and biopsy WITH CULTURE wich is more important
late term complications of pancreatitis, and their treatment
abscess. do ct. . drain
pseudocyst. do ct. <6cm and <6 weeks old. whatch and wait
>6cm>6weeks— DRAIN via endoscopy or percutaneous and Bx.
never open the belly while pancreatitis or its complications
