Gastrointestinal bleeding

Question 1

what is melena caused by

Answer 1

oxidation of Hb as it passes lower GI tract

Question 2

Bleeding that originates proximal to ligament of treitz is

Answer 2

Upper GI bleed

Question 3

Melena or hematemesis or brisk bleeding - hematochezia can suggest

Answer 3

upper GI bleed

Question 4

Organs proximal to ligament of treitz

Answer 4

esophagus
stomach
duodenum

Question 5

Organs distal to ligament of treitz

Answer 5

jejunum
ileum
colon

Question 6

Hematochezia or melena (from small bowel or right colon if slow) suggests

Answer 6

Lower GI bleed

Question 7

MOST common causes of Upper GI bleed

Answer 7

1) PUD
2) Varices
3) Esophagitis
4) MW tear

Question 8

If bleeding is non-variceal how long will it last

Answer 8

80% will stop on their own

Question 9

3 features make you worries about MASSIVE bleed

Answer 9

1) unstable hemodynamically
2) presents with hematochezia or frank hematemesis
3) blood transfusion needs

Question 10

3 features make you worries about WORSE outcome

Answer 10

1) > 60
2) concurrent illness
3) Onset WHILE hospitilized
4) coagulopathy

Question 11

First thing to do when managing an UGIB

Answer 11

1) resuscitate!

Question 12

Second thing to do when managing an UGIB

Answer 12

PPIs - give IV Bolus-infusion

Octreotide - only for variceal bleed

Question 13

For all UGIBs what medical therapy is given

Answer 13

PPIs - octreotide for variceal

Question 14

Third point in management of UGIB

Answer 14

Correct coagulopathy

Question 15

Fourth thing done in management of UGIB

Answer 15

Endoscopy to localize/treat bleed

Question 16

Resuscitation in UGIB

Answer 16

1) Airway
2) 2 LARGE bore peripheral IVs
3) Normal saline IV
4) packed RBC transfusion

Question 17

PPIs act on which cell in the stomach

Answer 17

Parietal cell, block acid production

Question 18

What does the higher pH promote?

Answer 18

Clot stability

Question 19

3 roles for endoscopy

Answer 19

1) diagnose
2) prognosis risk/stratify lesion
3) treat lesion - therapy

Question 20

2 low risk lesions

Answer 20

clean base/flat spot - NO ENDOSCOPic therapy

Question 21

Example of an intermediate lesion

Answer 21

Adherent clot - - consider therapy

Question 22

2 examples of HIGH risk lesions

Answer 22

Nonbleeding, but visible vessels

or active bleeding - MUST TREAT

Question 23

Medications used in endoscopy

Answer 23

• diluted Epi, Hemospray

Question 24

If you can’t stop the bleeding endoscopically

Answer 24

Angiography with embolization needed/surgery

Question 25

2 things happen when pressure goes up in portal system

Answer 25

1) Increased portal vascular resistance | 2) Vasodilation and splanchnic blood flow

Question 26

What should the difference between portal and systemic pressures be to get varices

Answer 26

12 mmHg at least

Question 27

Clinical risk factor for variceal bleeding is

Answer 27

severity of liver disease

Question 28

Endoscopic predictors of variceal bleeding

Answer 28

- size | - recent hemorrhage (wale marking, cherry spots)

Question 29

2 differences in treatment/management of varieal vs non-variceal blood

Answer 29

- Give octreotide | - Give prophylactic antibiotics

Question 30

endoscopically what is different from PUD vs variceal bleed

Answer 30

Band ligation used more than sclerotherapy

Question 31

If band ligation fails can use

Answer 31

TIPS

Question 32

what is the mechanism of action of octreotide in reducing portal hypertension

Answer 32

- vasoconstricts spanchnic vasculature | - given bolus-infusion

Question 33

what does a TIPS do?

Answer 33

shunts blood from portal vein to hepatic vein

Question 34

what are the risks of TIPs

Answer 34

encephalopathy, occlusion

Question 35

Difference between variceal and gastric varice?

Answer 35

- use gluing rather than banding

Question 36

when do you suspect that someone has an upper GI bleed presenting with hematochezia

Answer 36

- when hemodynamically unstable | - cirrhotic/NSAID/ Hx of PUD

Question 37

What are the causes of painless acute lower GIB

Answer 37

- Diverticulosis - Hemorrhoids - angiodysplasia - colon cancer/polyp - Meckel's

Question 38

Cause of a painful LGIB

Answer 38

anal fissure

Question 39

Causes of bloody diarrhea

Answer 39

- infectious colitis - ischemic colitis - IBD

Question 40

4 causes of Acute Lower GIB

Answer 40

- diverticulosis - angiodysplasia - ischemic colitis and hemorrhoids - neoplasia/other colitis

Question 41

Difference between UGIB and LGIB in terms of management

Answer 41

- LGIB - do a colonoscopy to treat and localize lesion

Question 42

if a patient cannot undergo colonoscopy what to do?

Answer 42

send for angiography - | RBC scan first to screen for active bleed

Question 43

2 scans before you send patients to angiography

Answer 43

CT angio or RBC scan