GI Bleed, GIBiome, C.diff Flashcards
Who gets GI bleeds?
Male
MC emergent indication for GI endoscopy EGD
Mortality LC- bleed continues and reoccurs
4 out 5 stop bleeding
Comorbid- Liver Dz, Portal HTN, cirrhosis
What are causes of GI bleed?
MC-Duodenal ulcer Gastric Ulcer Varices Esophagitis Demograph dependent
How is assessment and management determined?
Hemorrhagic shock Protection of Airway ASK- LFTs and Platelet count Anticoagulation NSAIDs? Smoking?
Mr. Heme c/c is coughing up blood? What is initial management?
Determine blood type and cross blood CBC/BMP NGT 2 Large bolus NS IVs HgB is Key PT INR O2 monitor
Mr. Heme has lost 1/2 of his blood? What is concern with Hgb
losing 1/2 Hgb will be the same
Hgb concentration/vol
If normal, still means GIB
What is dependent on mortaility?
Location in Hosp.
Floor, Home, ICU
Scope fast
What are highest risk of death
- Shock, red blood; low BP
- varices or cancer very bad
- Comorbid disease
- Older age
- Onset in hospital
- Recurrent bleeding
Mr. Heme had 12 unit of transfusion and PMH of chirrosis? What is death dependent on regarding units?
INC unit amount, INC cormorbid= HIGH mortality rate
What has the highest risk of rebleed and death?
Varices
Dilated tortuous veins w/in GI, esophagus*, etc
When are Nasogastric tubes placed?
Eval of GIB
DX- if W/D of blood
DX- severity and type bleed, coffee grounds, BRB, negative
What allows for clearance of stomach which can, reduce risk of aspiration, Clears the view for EGD?
Nasogastic Tube Easy to place Uncomfortable False Neg INC risk for sinusitis INC risk into bronchus
If blood get activated by bacteria in colon, and indicates initial bleed was high in GI tract? What color is stool?
Black Melena
tarry stools
Oxidized of iron on Hgb
Amount 50-100cc/mL
What color determines HUGE amount of blood in UGIB, and high risk based of NG eval?
Bright Red
30% mortality
How long can melena be present b4 seeing stool?
Week
MC is UGI source
Acute
What are risk if NG aspirate types of color of blood?
NG Red w/ Red stool 30%- EMERGENT
NG coffee ground w/ Red stool 20%
NG Red w/ Blk stool 12%
NG coffee ground w/ Black stool 9%
NG Clear w/ Red stool 7%
NG Clear w/ Black stool 5%
What will Endoscope provide for treatment of GIB?
Location
Severity- level of care
Acute vs Chronic
Eitology-TX, DX, Prognosis
What is the MC cause of UGIB?
Pelvic ulcer dz- artery
Gastric MC
Mr. Heme was taking NSAID due to his PMH of PUD. He was DX w/ H. pylori. Nothing was helping so he took NSAIDs due to pain. He also had PHM of cirrhosis and GERD? What are the his risk for PUD?
NSAIDs/ Aspirin
Helicobacter pylori infection
Physiologic Stress- life threatening illness)
Gastric Acid
Mr. Heme had a rebleeding, which of the following Stigmata posed 43% risk of rebleeding? Clean base Flat spot Adherent clot Non bleeding visible vessel Active bleed.
Non-bleeding visible vessel
Ulcer size and location may also affect the re-bleeding potential.
What is standard of care for PUD Upper GIB only?
Endoscopy Hemostasis
Triage and prognois
Dec Rebleed by 50%
NO affect on mortality
How do you manage PUD
IV Access Labs CBC, Platet, PT, PTT LFT Electrolytes NPO-no meal by mouth Resuscitation measures
The following are at risk for what? >60 Comorbity Hypotension RED blood stool and scope- active or visible vessel Shock Prolonged PT/cirrhosis Mental status
Risk for ICU surgery consults Endoscopy Hemostatsis Goal- prevent recurrent bleed
Mr. Cherry has clean base, no comorbity. What is his management?
Treat Ulcer
Early d/c
Medical ward admission
Why is it important to monitor pH in risk bleeder?
Low ph <7.4 reduced platelet aggregation
Clotting is PH dependent
Pepsin doesn’t work at pH of 1
