GI Bleeding Flashcards
1
Q
Initial evaluation of GI bleeding?
A
- History and Physical points to Source/Etiology
- History of Present Illness
- Attention to PMHx, Social Hx, Medications
2
Q
History in GI bleeding?
A
- Hematemesis (coffee grounds vs. bright red)
- Hematochezia - bright red stained stool
- Melena - dark, tarry stool
- Pain symptoms
- Medications – NSAIDs, steroids, ASA, clopidogrel, warfarin, Heparin, Iron
- PMHx - arthritis, ulcer disease, EtOH
3
Q
Physical exam of GI bleeding?
A
- HR, BP, RR, O2 saturation
- General appearance, Mental status
- Neck veins, oral mucosa
- Skin temperature and color
- Abdominal exam
- Rectal
- Stigma of Cirrhosis
- NG Tube findings (upper vs. lower g.i. source)
- Urine output
4
Q
Sources of GI bleeding?
A
- Upper GI Tract
- Proximal to the Ligament of Treitz
- 70% of GI Bleeds - Lower GI Tract
- Distal to the Ligament of Treitz
- 30% of GI Bleeds
5
Q
Localization of bleeding?
A
- History
- NG Tube
- EGD
- Colonoscopy
- Tagged RBC Scan
- Angiography
6
Q
Presentation of upper GI bleed?
A
- 50% present with hematemesis
- NGT with positive blood on aspirate
- 11% of brisk bleeds have hematochezia
- Melena (black tarry stools)
- this develops with approximately 150-200cc of blood in the upper GI tract
- Stool turns black after 8 hours of sitting within the gut.
7
Q
Risk factors of upper GI bleed?
A
- NSAID use
- H. pylori infection
- Increased age
8
Q
Etiology of upper GI bleeding?
A
- Duodenal Ulcer-30%
- Gastric Ulcer-20%
- Varices-10%
- Gastritis and duodenitis-5-10%
- Esophagitis-5%
- Mallory Weiss Tear-3%
- GI Malignancy-1%
- Dieulafoy Lesion - large tortuous arteriole running close to the mucosa of the stomach
- AV Malformation-angiodysplasia
9
Q
What is esophagitis?
A
Inflammation that damages the tube running from the throat to the stomach (oesophagus)
Causes include
1. stomach acids backing up into the tube
2. infection
3. some medication
4. allergies
10
Q
What is an esophageal tumor?
A
11
Q
What is gastric carcinoma?
A
12
Q
What is angiodysplasia?
A
13
Q
Presentation of lower GI bleeding?
A
- Hematochezia
- Blood in Toilet
- Clear NGT aspirate
- Normal Renal Function
- Usually Hemodynamically stable
- Only 1/3 of patients with lower GI bleeds have positive orthostatics (tilt test).
14
Q
Etiology of lower GI bleeding?
A
- Diverticular-20%
- AVM-10%
- Malignancy-2-26%
- Inflammatory Bowel Disease-10%
- Ischemic Colitis
- Acute Infectious Colitis
- Radiation Colitis/Proctitis
- Aortoenteric Fistula
15
Q
What is diverticulosis?
A