GI Bleed Lecture Flashcards
Causes of gastric and/or duodenal ulcers
NSAIDs
Stress (ICU)
Cause of esophagogastric varices?
Cirrhosis
Causes of erosive esophagitis, gastritis, duodenitis
Candida
ETOH
Cause of portal HTN gastropathy
Cirrhosis
Angiodysplasia (aka vascular ectasia) is caused by…
sequela of other disease (renal, cardiac, hepatic)
Mass lesions are caused by…
Polyps
Cancer
Mallory-Weiss is caused by…
Repetitive retching
what percentage of GI bleeds have no lesion identified
10-15%
Stomach pain (severe with involuntary guarding or rebound tenderness)
Hematemsis
Melena
Hematochezia
Clinical presentation of GI bleed
Frank blood hematemesis=
vigorous, active bleed
Coffee ground hematemesis=
slower, limited bleeding
Black tarry stools
Non specific, seen in various bleeds
can show up with as little as 50 cc of blood
Melena
Melena can be seen with as little as ____ cc of blood
50
Bright red to maroon
ususally seen in lower GI bleed
Hematochezia
Hematochezia + hypotension (+/- signs of upper bleed) =?
MASSIVE UPPER GI BLEED!!
>20:1 BUN to Creatinine ratio indicates…
upper GI bleed
What is the order of severity for these:
A. tachycardic with normal BP
B. stable vitals
C. supine hypotension
D. orthostatic hypotension
Best to worst:
- stable vitals
- tachycardic with normal BP
- orthostatic hypotension
- supine hypotension
Orthostatic hypotension indicates about a ___% total volume loss
15%
Supine hypotension indicates about a ___% total volume loss
40%
What is approx. the max survivable blood loss?
40%
(~40% total volume loss= supine hypotension)
How often should you recheck H+H?
q4-6 hours
What labs should you order for a GI bleed pt?
CBC
CMP
Coag panel
Type and cross
Reported or witness GI blood loss
Normal vitals
+/- tachycardia
..urgent or non urgent?
Non urgent
GI consult, IV PPI, transfuse?, upper endoscopy later today or tomorrow
Hypotension with frank blood (witnessed or reported)
emergent or non urgent?
EMERGENT!!!!
Cardiac monitoring, frequent BP checks
Est 2 large bore IV sites
IVF (at least 500 cc wide open)
O2
Prepare to transfused, IV PPI
IV octreotide (if variceal bleed suspected)
IV reversal agents
Call GI for urgent endoscopy
Call gen surgery, call intensivist
actions to take in a GI bleed emergency
(ie hypotension with frank blood)
Measure H+H over time (q4 hours is common)
a ___gram drop is significant!!
1 gram
(ie 10.0 to 8.9)
Cirrhosis
Vigorous bleeding with high rebleed risk
tx= octreotide
Endoscopy
Transjugular Intrahepatic Portosystemic Shunt (TIPS)
Variceal bleed
How do you reverse effects of anticoagulated pts in a non urgent GI bleed?
Vitamin K IV or PO
How do you reverse effects of anticoagulated pts in a emergent GI bleed?
KCentra + IV Vit K
Causes:
Hemorrhoids
Diverticular dz
Colitis
Colon cancer
*first R/O upper bleed, then process to colonscopy
Lower GI bleeds
