GI Bleed Flashcards
common cause of gastric and/or duodenal ulcers
NSAIDs
stress (ICU)
common cause of esophagogastric varices
cirrhosis
common cause of severe or erosive esophagitis, gastritis, duodenitis
candida
ETOH
common cause of portal hypertensive gastropathy
cirrhosis
common cause of angiodyplasia
sequlea of other diseases (renal, cardiac, hepatic)
common cause of mass lesions
polyps
cancer
common cause of Mallory-Weiss syndorme
repetitive retching
what percentage of patients with a GI bleed have no lesion identified?
10-15%
clinical manifestations of a GI bleed
belly pain
hematemesis
melena
hematochezia
what should we think with severe belly pain with involuntary guarding or rebound tenderness?
consider perforation
what should we think with frank blood in vomit?
vigorous active bleed
what should we think with coffee ground apperance in vomit?
slower, more limited bleeding
is melena specific or nonspecific?
nonspecific
when hematochezia is accompanied by hypotension (+/- signs of UGI bleed) it indicates what?
MASSIVE upper bleed
orthostatic hypotension indicates ____ % total volume losss
15%
supine hypotension indicates ____ % total volume loss
40%
normal volumes of blood for:
males?
females?
male- 5.6L
female- 4.5L
what is the maximum survivable blood loss?
about 40%
testing everybody gets with a GI bleed
CBC - H&H, platelets
CMP- BUN (upper bleed), platelets (severe thrombocytopenia)
coagulation panel (anticoagulation)
type & cross- anticipate need for transfusion
how often should we repeat an H&H on a patient with a GI bleed?
every 4-6 hours
what makes a GI bleed non-urgent?
report or witnessed GI blood loss + normal vitals +/- tachycardia
management for non-urgent GI bleed
GI consult
IV PPI, may transfuse
upper endoscopy today or sometime tomorrow
what makes a GI bleed an emergency?
hypotension (of any kind) + frank blood (witnessed or reported)
management for an emergent GI bleed
cardiac monitoring & frequent BP vhecks, O2
2 large bore IV sites, bolus IVF (at least 500cc), prepare to transfuse
IV PPI, IV Octreotide, IV reversal agent (if anticoagulated)
call GI for urgent endoscopy, call surgery & intensivist
what is considered a significant drop in H&H in a GI bleed patient?
1 gram drop
*caution- hemodilution can throw you off*
blood digestion and reabsorption can _______ serum BUN
increase
what BUN to Creatinine Ration indicates an UPPER GI bleed?
> 20 : 1
what are some causes of lower GI bleeds
hemorrhoids
diverticular disease
colitis
colon cancer
what do we do if we suspect a lower GI bleed?
first we want to rule out an upper bleed
then proceed wtih colonoscopy
what do we do if for our anticoagulated patient (on Coumadin) presenting with a GI bleed?
non-urgent reversal?
emergent reversal?
stop the medication
call the Pharm D
reverse the effects- INR > 1.5,
vitamin K IV or PO or non-urgent reversal
Kcentra plus IV vitamin K for emergency reversal
what do we do if for our anticoagulated patient (on direct oral anticoagulants) presenting with a GI bleed?
call the pharm D
this is new & changed every day
