GI Bleed Lecture Powerpoint

Question 1

Hematemesis

Answer 1

Frank bright red bloody vomit

Question 2

Coffee ground emesis

Answer 2

Vomiting of digested blood

Question 3

Ligament of treitz divides these 2 conditions

Answer 3

Upper GI vs lower GI bleed

Question 4

HemOCCULT testing

Answer 4

Taking a sample of stool, placing it on a card that then undergoes reagant droplet testing, with blue color meaning that it contains blood

Question 5

HemOCCULT positve with iron deficiency anemia vs negative with iron deficiency anemia protocol

Answer 5

+ requires EGD and colonoscopy

- just a colonoscopy

Question 6

Heme+ stool with iron deficiency anemia with normal EGD/colonscopy protocol (4)

Answer 6

• Wireless capsule endoscopy (pill camera thanks big government)
• double balloon push enteroscopy
• repeat EGD/colonoscopy
• wait and observe

Question 7

1 cause of upper GI bleed and 2 others

Answer 7

• peptic Ulcer disease (erosions of esophageal, stomach, or duodenum)
• mallory weiss tear (often in chronic coughers or violent vomiters)
• esophageal varices

Question 8

Mallory weiss tear

Answer 8

Uncommon cause of upper GI bleed, longitudinal mucosal laceration at the gastroesophageal junction or the gastric cardia caused by forceful retching or vomiting, often associated with alcohol use, overt bleeding is minor and bleeding ceases spontaneously unless severe then need intervention

Question 9

Bleeding varices

Answer 9

An uncommon cause of upper GI bleed due to friable weak tissue that usually resultes in sudden overt major bleeding, can be fatal

Question 10

AIMS65 score

Answer 10

Predictor of in hospital mortality due to upper GI bleed based on risk factors
Albumin <3g/dL (produced by liver and keeps fluid in circulation)
INR greater than 1.5 (can’t spontaneously clot)
-Mental status <14 of glascow coma score
Systolic BP <90
Age greater than 65

Question 11

Diverticular bleed #1 site

Answer 11

Ascending colon

Question 12

Diverticular bleed does not necessarily mean a patient has…

Answer 12

…diverticulitis (this one is more common on the sigmoid colon on the left and is infectious while diverticular bleed is ascending colon most of time, and typically painless and stop spontaneously)

Question 13

Lower GI sources of blood loss (5)

Answer 13

• diverticular bleed
• polyp/cancer
• angiodysplasia
• IBD
• hemorrhoid or fissure

Question 14

Rare cause of lower GI bleed seen in patients with prior surgery of the abdomen

Answer 14

-erosion resulting in aortoenteric fistula resulting in a “herald bleed”

Question 15

Postural hypotension

Answer 15

Supine to upright fall in systolic BP of >10mmHg or increase in heart rate of >20 bpm indicating a moderate blood loss (up to 20% of circulatory volume)

Question 16

If a patient is in a deep GI bleed, we want to do what?

Answer 16

Give O neg blood cells until blood type identified, lacted ringer’s solution, no vasopressors (it will just cause them to squirt)

Question 17

Intrahepatic portosystemic shunt

Answer 17

Used in upper GI bleed secondary to esophageal varicies to treat portal hypertension by percutaneously creating a connection within the liver between portal and systemic circulations (diverting portal blood flow)