GI Bleed Flashcards
What does the ligament of Treitz separate?
It separates the upper GI from the lower GI - the upper GI goes from the esophagus to 3rd part of the GI with the lower GI being the rest of the tract
What are some symptoms of upper GI bleed?
- Hematemesis – “coffee-ground”, bright red blood
- Melena – black, tarry stool
- Hematochezia – bright red blood per rectum
- Occult blood
What are the main 4 differential diagnoses for upper GI tract bleed?
Peptic Ulcer
Esophageal Varices
Erosive Esophagitis
Mallory Weiss Tear
What are the main causes of peptic ulcer disease?
- Helicobacter pylori
* NSAIDS/ASA
What is the treatment for PUD?
• Decrease NSAID/ASA use
• H2 blockers (ranitidine, etc.)
• Proton Pump Inhibitors
– Triple Therapy for H. pylori infection
What is the main cause of esophageal varices?
Portal HTN
What are some of the causes of erosive esophagitis?
- Reflux
- Pill-induced
- Infectious (Candida, CMV, HSV)
- Radiation
- Eosinophilic Esophagitis
Mallory-Weiss Tear
- Hematemesis after violent retching/vomiting
* Usually self-limited, rarely life-threatening
What is the consensus for the use of nasogastric aspiration in the diagnosis of GI bleeds?
Generally avoided, although when used, a positive result is highly indicative, however, a negative result is largely inconclusive and will require endoscopy anyways.
Why are Pre-endoscopic IV Proton Pump Inhibitors used?
They have no impact on mortality, rebleeding or
need for surgery BUT the do accelerate resolution of bleeding and decreases need for endoscopic therapy
What are the 2 greatest risks for rebleeding in the upper GI tract?
- Active bleeding during endoscopy
* Ulcer greater than 2cm
Why are Post-endoscopic IV PPIs used?
Post-endoscopic IV PPI x 72 hours decreases recurrent bleeding, need for surgery and mortality in high-risk ulcers
What are the main 4 differential diagnoses for lower GI tract bleed?
Diverticulosis
Colitis
Hemorrhoids
Postpolypectomy
Diverticulosis
- Asymptomatic mucosal outpouchings
* Acute, painless bleeding
What is the most common site of diverticulosis?
Sigmoid colon, but can occur anywhere
