Gastrointestinal Bleeding Flashcards
What is the dividing point between the upper and lower GI
the ligament of Treitz. Bleeds beyond this point are unlikely to be vomited up
What is a sign of occult GI bleed
anemia, which is why every case of anemia must be worked up thoroughly
What are signs of instability in blood loss
tachycardia, low BP, dizziness
What is appropriate course of action if an upper GI bleed is suspected
at least call the ER to consult if the patient is stable. Upper GI bleeds are considered medical emergencies
What is endoscopy preferred over barium for visualizing upper GI bleed
You can visualize, treat, and biopsy all in one fell swoop
What is a ddx for upper GI bleed
PUD, bleeding esophageal varices, Mallory-Weiss tears, esophageal rupture, Boerhaave’s syndrome, bleeding gastric varices, angiodysplasia and cancer
What most often causes esophageal varices
liver cirrhosis (alcohol and Hep C)
How doe boerhaave’s syndrome and mallory-weiss tears differ
Boerhaave’s is transmural esophageal perforation, generally worse and hurts way more, and the blood leaks anywhere. Mallory-Weiss is a partial thickness tear near the LES and the blood stays local within the GI tract.
What is angiodysplasia
AV malformation, artery meets up with a vein without capillaries to buffer the pressure difference (happens in >70 yo)
What are the ssx of AV malformation
chronic, slow forming bleed, painless. usually iron deficiency anemia
what are complicating factors in bleeding esophageal varices
liver cirrhosis means the patient has poor clotting ability; infix by gram neg bug often concomitant or precipitant. Often require transfusion
What are the main treatments for esophageal varices
variceal ligation (banding), or sclerotherapy (hypertonic saline, tetracycline). Acutely, it is fixed with endoscopy
What is the presentation of bleeding PUD
hematemesis, coffee ground vomiting, melena, or hematochezia (maroon colored stool if the hemorrhage is severe)
Patients may also present with complications of anemia, including fatigue, chest pain, syncope and shortness of breath
What common substances can turn stool black
Besides an upper GI bleed, bismuth (found in antacids), activated charcoal. Melena will be sticky and smell intensely foul
What does bright red blood in the stool mean
Normally it is an indication of a lower GI bleed, but an arterial/intense upper GI bleed could go rapidly through transit and cause bright red blood in the stool
What are the most common causes of PUD bleeds
H. pylori, NSAID use, ASA; to a lesser extent SSRIs, corticosteroids, and anticoagulants.
What parameters are checked in the Glasgow-Blasford scoring
Hemoglobin level >12.9 g/dL (men) or >11.9 g/dL (women)
Systolic blood pressure >109mm Hg
Pulse
What is the Rockall scoring system
used to determine whether an upper GI bleed should be scoped and risk of adverse outcome
what are common causes of lower GI bleed
Diverticulosis, diverticulitis Crohn’s disease Ulcerative colitis Ischemic colitis Infectious colitis esp. E. coli O157:H7, Shigella, Salmonella, Campylobacter jejunai Angiodysplasia Neoplasm, polyps, cancer Hemorrhoids, anal fissures
What is hematochezia
blood in the stool that is not melenic. It will be red or maroon in color, with the blood being darker the longer it is in the GI tract
What is a true diverticulum
An out pouching that involves all layers of the bowel wall
What is are potential outcomes of diveticulosis
diverticulitis, perforation (blood in the peritoneum is exquisitely painful)
What are the ssx of UC
bloody diarrhea, hemorrhage (more common in UC than in Crohn’s)
What are signs of massive lower GI bleeds
Normally in patients over 65:
Systolic blood pressure of less than 90 mm
Hemoglobin levels of
What are indications for surgery
Persistent hemodynamic instability with active bleeding.
Persistent, recurrent bleeding.
Transfusion of more than 4 units packed red bloods cells in a 24-hour period, with active or recurrent bleeding.
What is the work up of choice for lower GI bleed
Colonoscopy. If that fails to find source of bleeding, followed by angiography
