GI Bleed Flashcards
Organs involved in upper GI bleed
Esophagus, stomach, duodenum (treitz angle)
Lower GI bleed-organs involved
Jejunum, ileum (ileocecal valve), colon, rectum
What is guiac positive stool
Occult blood in stool, does not provide localizing information. Indicates slow pace, low volume bleed
What is melena
Very dark, tarry, pungent stool. Usually suggestive of UGI origin (but can be small intestine, proximal colon origin if slow pace)
What is hematochezia
Spectrum: bright red blood, dark red, maroon. Usually suggestive of colonic origin, but can be UGI
Common differentials for upper GI bleeds
Peptic ulcer disease, erosive esophagitis/gastritis/duodenitis, gastroesophageal varices, aortoenteric fistula, etc.
Common differentials for lower GI bleed
Diverticulitis-particularly in elderly. Hemorrhoids, angiectasis
What are predictors of upper GI source?
Age under 50, melenic stool, BUN/Creatinine ratio greater than 30
When use NG tube
Pts with severe hematochezia and unsure if UGIB vs LGIB. Positive aspirate indicates UGIB
How do you resuscitate a pt with blood loss
Give volume, use crystalloids first bc blood needs to be matched before administered.
What is AIMS65?
Way to gauge sicknss of pt. Albumin 1.5, Mental status altered, systolic BP
Pre endoscopic pharmacotherapy for non variceal UGIB
IV proton pump inhibitors
When is endoscopic therapy required?
Active bleeding, nonbleeding visible vessel.
What does endoscopic hemostasis therapy entail
Epi injection, thermal electrocoagulation, mechanical (hemoclips)
In pts with cardiovascualr disease on low dose aspirin, what should we do once bleeding stops?
Restart aspirin as soon as bleeding resolved.
