GI bleed Flashcards
why is the BUN/Cr ration >36 during upper GI bleed?
urea reabsorbed and Cr not in GI tract
+
pre-renal azotemia from volume depletion
What are the top 5 causes of upper GI bleed?
PUD varices gastritis/gastropathy erosive esophagitis mallory-weiss
what are the top 5 causes of lower GI bleed
diverticular hemorrhage cancer colitis-infectious, ischemic, IBD angiodysplasia anorectal
FOBT guaiac? highly sensitive or specific?
sensitive, but not specific
does FOBT fit test detect upper and lower bleeds?
no- lower only
Iron and pepto-bismal darken the stool but…?
will not yield a false positive on the FOBT test
what are some false positive FOBT foods?
red meat, cantaloupe, melons, grapefruit, figs, broccoli, turnips, cauliflower
what is the sign of 10% volume loss
tachy
what is the sign of 20% volume loss
orthostatic hypotension
what is the sign of 30% volume loss
hypotension/shock
What labs should we order for GI bleeds
CBC, INR/PT,PTT, BMP, LFT, TYPE AND CROSS
How do we treat GI bleed acute
- assess loss
- resuscitate- 2 large bore IVs–> NS until stable vitals +normal urine output+ normal mental status
- transfuse- acute even if Hb>7, Hb50k)
- ICU if unstable Vitals or end-organ damage
What should the initial work up of GI bleed be like?
- NG tube- fresh blood, coffee grounds, non-bloody bile (Lower bleed)
- Endoscopy- evaluate for upper and treat upper
- colonoscopy- do after endoscopy
What are our options for unstable/recurrent GI bleed evaluation?
tagged RBC >.1 mL/min- to localize only
arteriography- can localize >.5 and can treat
Obscure GIB- ongoing bleeding with negative EGD and colonoscopy should follow what protocol?
repeat EGD with push enteroscopy if it is active
capsule endoscopy
Tc pertechnetate, tagged RBC, arteriography
What is the treatment for acute variceal hemorrhage?
- stabilize
- octeotride and ceftriazone (SBP prophylaxis)
- band ligation or TIPS if refraactory
What is used for portal hypertension variceal prophylaxis?
propranolol
what are non medication treatments for GERD
weight loss, elevate head of bed, don’t eat late, stop smoking
dietary- avoid large fatty meals, coffee, chocolate, peppermint, onions, garlic, EtOH
if barretts has no dysplasia…how often do we need EGD?
3-5 years
if low grade 6-12 months
what is Rx: for barrett’s low grade vs high grade dysplase?
low- surveillance EGD
high- surgical resection +ablation
what can cause false negatives when testing for Hpylori
PPI for urea breath test and stool antigens
how do we treat Peptic ulcer
PPI
endoscopy+biopsy
mucosal protection- bismuth
What is the triple and quadruple therapy for H. pylori
- PPI, clarithromycin, amoxicillin
2. PPI, metro, tetra, bismuth
