Gastrointestinal Bleeding Flashcards
can see black dotted stools
Overt Bleeding
not able to see source of bleeding on endoscopy/colonoscopy
Obscure Bleeding
need to test the stool to find blood
Occult Bleeding
- ULCERS
- TEARS
- ANGIOECTASIAS
- TUMORS
Non-Variceal Bleeding
- portal HTN causes backward pressure
- commonly due to advanced cirrhosis or continued alcohol use
- ESOPHAGEAL VARICES: via coronary vein
- GASTRIC VARICES:
- greater curvature via splenic vein
Band ligation only for esophageal varices, not gastric varicose
Variceal bleeding
- most common cause of GI bleeding
- Gastric ulcers are the most common within the GI
- Most commonly caused by H. pylori or NSAIDs
Ulcers
- Curved gram-negative rod
- Diagnose by testing for urease (breath test)
- CagA protein: associated with more inflammatory-type ulcer
- Triple therapy to eradicate: proton pump inhibitor, clarithromycin, amoxicillin (or metronidazole)
H.pylori
passage of fresh blood through the anus, usually in or with stools
- Usually associated with lower GI bleeds, but can be due to upper GI bleeds
Hematochezia
- Take vitals and start resuscitation (irrespective of cause/source of bleeding) prior to endoscopy, etc.
- Have 2 large IV fluid bags on hand to restore blood volume
- Protect patient’s airway: don’t want Pt to aspirate blood, especially nasogastric aspirate
- If tachycardic and hypotensive (loss of >1L of blood): ICU
- if Young patient w/ minor bleeding, no anemia: Outpatient
Initial Management of UGIB
Injection: Epinephrine
Cautery: heat/laser
Mechanical: banding
Endoscopic hemostasis
- longitudinal mucosal lacerations at the gastroesophageal junction due to severe vomiting/retching
- leads to hematemesis
- usually found in alcoholics or bulimics
Mallory-Weiss Syndrome
Vomiting of blood
Hematemesis
- a large tortuous arteriole in the stomach wall that erodes and bleeds
- M:F 2:1
Dieulafoy’s Lesion
- Diverticulosis
- Angiodysplasia
Lower GI Bleeds
- Outpouschings of mucosa and submucosa through the muscular is propria (a pseudodiveritculum)
- associated with constipation, straining, and low-fiber diet
- Can cause rectal bleeding/hematochezia
- commonly seen in older adults
- Sigmoid colon is the most common location
Diverticulosis/Colonic Diverticula
Acquired malformation of mucosal and submucosal capillary beds
- reputure classically presents as hematochezia in older adults
Angiodysplasias
- black, “tarry” feces that are associated with gastrointestinal hemorrhage
- black color is caused by oxidation of the iron in hemoglobin during its passage through the ileum and colon
Melena
