GI BLEEDING Flashcards
initial presentation of a positive fecal occult
blood test result and/or iron deficiency anemia when there is no evidence of visible blood loss
to the patient or physician.
(Acute Upper GI Bleeding)
Occult gastrointestinal (GI) bleeding
the term overt is used to describe what
Acute Upper GI Bleeding
blood loss that is visible to the patient or
clinician. Overt bleeding may manifest as hematemesis, melena, or hematochezia.
what is the most common source of lower gastrointestinal blood loss, but the
bleeding is often occult
(Acute Upper GI Bleeding)
Colon carcinoma
Essentials of Diagnosis
Acute Upper GI Bleeding
(a) Hematemesis (bright red blood or “coffee grounds”).
(b) Melena in most cases; hematochezia in massive upper gastrointestinal bleeds.
(c) Volume status to determine severity of blood loss; hematocrit is a poor early
indicator of blood loss.
(d) Endoscopy diagnostic and may be therapeutic
what is The most common presentation of upper gastrointestinal bleeding
(Acute Upper GI Bleeding)
hematemesis or melena.
Is an upper GI bleeding self-limiting
Acute Upper GI Bleeding
yes
Patients with bleeding more than 48 hours prior to presentation have a low or high risk of recurrent bleeding
(Acute Upper GI Bleeding)
low
Acute upper gastrointestinal bleeding may originate from what two conditions listed in the TG
(Acute Upper GI Bleeding)
(b) Peptic Ulcer Disease- Account for half of all major upper gastrointestinal
bleeding with an overall mortality rate of 4%.
(c) Mallory-Weiss Tears- Lacerations of the gastroesophageal junction cause 5-
10% of cases of upper gastrointestinal bleeding. Many patients report a
history of heavy alcohol use or retching.
A systolic level of what identifies a high-risk patient with
severe acute bleeding.
(Acute Upper GI Bleeding)
A systolic blood pressure less than 100 mm Hg
A heart rate over what paired with a systolic blood pressure of what
signifies moderate acute blood loss
(Acute Upper GI Bleeding)
100 beats/min with a systolic blood pressure over 100 mm Hg
What systolic blood and heart rate suggest relatively minor
hemorrhage.
(Acute Upper GI Bleeding)
A normal systolic blood pressure and heart rate
Is hematocrit a reliable indicator of the severity of acute
bleeding
(Acute Upper GI Bleeding)
Because the hematocrit may take 24-72 hours to equilibrate with the
extravascular fluid, it is not a reliable
A nasogastric tube should be placed in all patients with suspected _____
(Acute Upper GI Bleeding)
active
upper tract bleeding.
RAD / Imaging
Acute Upper GI Bleeding
(a) Upper endoscopy
Labs
Acute Upper GI Bleeding
CBC
PT/PTT and INR
Blood type and Screening
Patients with evidence of hemodynamic compromise are given
Acute Upper GI Bleeding
0.9% saline or
lactated Ringer injection and cross- matched for 2-4 units of packed red
blood cells
NG tube placement.
Periodic reaspiration of the nasogastric tube serves as an indicator of
(Acute Upper GI Bleeding)
ongoing
bleeding or rebleeding.
Pharmacologic therapy:
Acute Upper GI Bleeding
Proton Pump Inhibitor
Essentials of Diagnosis
(a) Hematochezia usually present.
(b) Evaluation with colonoscopy in stable patients.
(c) Massive active bleeding calls for evaluation with sigmoidoscopy, upper endoscopy, angiography, or nuclear bleeding scan
(d) Diverticulosis
(e) Inflammatory Bowel Disease
(f) Anorectal Disease
Diverticular bleeding usually presents how
acute, painless, large- volume maroon or
bright red hematochezia in patients over age 50 years.
_____ should be considered for patients who have had multiple
episodes of diverticular bleeding and are good surgical candidates. (Diverticular)
surgery
Brown stools mixed or streaked with blood predict
a source in the rectosigmoid
or anus.
Large volumes of bright red blood suggest
a colonic source.
Maroon stools imply
lesion in the right colon or small intestine
Black tarry stools (melena) predict
a source proximal to the ligament of Treitz.
a source proximal to the ligament of Treitz.
ligament of
TreitZ
Painless large-volume bleeding usually suggests
diverticular bleeding.
Labs
(a) CBC
(b) PT/PTT and INR
(c) Blood Type and Screen
RAD/Imaging
(a) Colonoscopy
Treament
a) Initial stabilization, blood replacement, and triage are managed in the same
manner as described above for Acute Upper gastrointestinal bleeding.
(b) Treating the underlying cause is the goal of therapy
