Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Surgery/ER Fall 2013 > GI Bleeding > Flashcards

GI Bleeding Flashcards

You may prefer our related Brainscape-certified flashcards:
Royal College: Emergency Medicine flashcards
1
Q

ligament of tretz

A

proximal to ligament of treitz- upper GI bleeding. distal to ligament of treitz- lower GI bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

ligament of treitz separates

A

duodenum from jejunum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

UGI bleeding prognosis

A

self limited in 80%. remaining 20%- medical therapy and EGD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

causes of acute UGI bleeding

A

PUD (most common), portal HTN, mallory weiss tear, vascular anomalies, gastric neoplasm, erosive gastritis, erosive esophagitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

incidence of bleeding from peptic ulcer dz is decreasing d/t

A

tx of h. pylori and tx with PPI’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

tx of portal hypertension

A

IV octrotide infusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

portal HTN causing acute UGI bleeding most often d/t

A

varices (esophageal, gastric, duodenal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

tears at the GE junction d/t retching

A

mallory-weiss tears

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

mallory -weiss tears most commonly occur in what type of patients?

A

alcoholics and bulemics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

vascular anomalies causing acute UGI bleeding include

A

angioectasias (1-10 mm dialted submucosal vessels), telangectasias (dilated venules), and Dieulafoy’s lesions (dilated artery in proximal stomach)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

angioectasias most common in

A

right colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

erosive gastritis causing acute UGI bleeds d/t

A

NSAIDS, alcohol, or severe medical or surgical illness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

erosive esophagitis causing acute UGI bleeds (rare) results form

A

chronic GERD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Is hgb/hct helpful in determing severity in GI bleeding?

A

may take 1-3 days to equilibrate so do not rely on this value

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

management/tx of acute UGI bleed

A

strat with looking at VS (Hgb, BP, PP, HR,, UO, MS). if normal, check orthostatics. Get labs- CBC, PT, chem 7, LFT, type and screen. Hook up 2 large bores- IVF. type and cross 2-4 units if severe bleeding. CVP monitoring, NG tube. risk stratification to determine EGD within 2-4 hours or within 24 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

If need to clear stomach in case of upper GI bleed

A

don’t do gastric lavage. use IV erythromycin to clear stomach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

NG aspirate of red blood or coffee grounds=

A

confirms UGI source of bleeding.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Bright red blood vs. clear aspirate from NG tube

A

high risk of complications. if clear= duodenal source of bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

blood replacement in acute UGI bleeding

A

Hgb should raise 1 gram for each unit of PRBC’s given. In massive bleeding, give 1 unit FFP for every 5 units of PRBC’s.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

when is FFP given in acute UGI bleeding

A

If massive bleeding or if patient with coagulopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

when are platelets transfused in acute UGI bleeding?

A

if less than 50,000 or if patient has taken ASA or clopidogrel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

when is DDAVP given in acute UGI bleeding

A

uremic patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Hgb should be kept in range of ___ in acute UGI bleeding replacement

A

6-10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

low risk- acute UGI bleeding

A

no evidence of active bleeding. admit to GMB or stepdown. EGD within 24 hours.

25
Q

high risk indications and management - acute UGI bleeding

A

hematemesis, bright red blood per NG, shock, advanced liver disease, hypovolemia unresponsive to resuscitation. serious comorbid disease. ADMIT TO ICU, EGD WITHIN 2-4 HOURS

26
Q

History is only 40% accurate, so __ used to identify source of bleeding in acute UGI bleeds

A

EGD

27
Q

meds for acute UGI bleeding

A

IV “prazole” (PPI) or high dose oral PPI prior to EGD. intra-arterial embolization, TIPS, surgery

28
Q

95% of LGI bleeding is from

A

colon

29
Q

most common cause of LGI bleed

A

diverticulosis

30
Q

most common cause of UGI bleed

A

peptic ulcer disease

31
Q

what increases risk of diverticulosis

A

ASA and NSAIDS

32
Q

causes of acute LGI bleeding

A

diverticulosis, angioectasias, neoplasms, IBD, anorectal disease, ischemic colitis, infectious colitis

33
Q

most common to see those over 70 yo and in patients with renal failure (acute lower Gi bleeding cause)

A

angioectasias

34
Q

BRBPR in patients over 50, PAINLESS

A

diverticulosis

35
Q

most common diagnostic instruments to determine source of bleeding in UGI and LGI bleeds

A

EGD, colonoscopy. If massive LGI bleeding in hemodynamiccally unstable patient, do angiography

36
Q

diarrhea w/intermittent hematochemize, abd pain, tenesmus, urgency of stool

A

IBD

37
Q

bright red blood that drips into toilet after BM

A

anorectal disease (hemorrhoids, fissures, stercoral ulcers)

38
Q

where does ischemic colitis occur

A

“watershed” areas of colon

39
Q

Diagnosis of acute lower GI bleed

A
  1. exclude UGI source. 2 anoscopy/sigmoidoscopy. 3. colonoscopy 4. tagged RBC scan 5. angiography 6. small intestine push enteroscopy 7. capsule endoscopy
40
Q

how to exclude UGI source in diagnosis of LGI bleed

A

if unstable patient, NG tube for aspiration. EGD performed in patients with hematochezia and hemodynamic instability

41
Q

If patient presents with LGI bleeding, is younger than 45, and has small volume bleeding–>

A

anoscopy/sigmoidoscopy to look for anorectal dz, IBD, infectious colitis

42
Q

bowel prep done in most cases for colonoscopy- this is performed within 24 hours vs. 2 hours if…

A

24 hours if bleeding minimal. within 2 hours of prep if bleeding severe

43
Q

embolization of bleeding vessel effectively stops bleeding in 95%. but complication rate 5%-

A

ischemic colitis

44
Q

acute lower GI bleeding diagnostic instrument used to identify lesions in small intestine

A

push enteroscopy

45
Q

negatives of capsule endoscopy

A

gretaer potential for hemorrhage, hard to locazline bleeding site

46
Q

tx for acute LGI bleeding

A

colonoscopy (cautery), angiography with embolization, surgical tx

47
Q

surgical tx indications in acute LGI bleeding tx

A

ongoing bleeding, or if transfusion requirements are more than 6 units in 24 hours, or if 2 or more hospitalizations for diverticular hemorrhage

48
Q

segmental colon resection vs. subtotal colectomy

A

if preoperative localization done by antiography or tagged RBC scan, then segmental colon resection. if source of LGI bleed cannot be localized, do subtotal colectomy

49
Q

obscure Gi bleeding -

A

bleeding of unknown origin that persists or recurs after negative EGD and colonoscopy

50
Q

obscure GI bleeding most commonly arises from lesions in

A

small intestine. (1/3 are missed lesions of stomach or colon)

51
Q

etiology of Obscure GI bleeding

A

if over 40, NSAID induced or angioectasias. if uncer 40, SB neoplasm, crohn’s, celiac dz, meckel’s diverticulum

52
Q

evaluation of younger patients and symptomatic older patients for obscure GI bleeding

A

EGD and colonoscopy to r/o missed lesion, capsule endoscopy if scopes are negative. add meckel’s scan if younger than 30

53
Q

occult Gi bleeding is how much

A

less than 100 ml/day (not apparent to patient)

54
Q

occult GI bleeding identified by

A

FOBT or iron deficiency anemia (serum ferritin less than 30-45 mcg/L

55
Q

occult GI bleeding that is asymptomatic , positive FOBT

A

colonoscopy

56
Q

occult GI bleeding that is symptomatic, positive FOBT

A

colonoscopy and EGD

57
Q

if patient is greater than 60 without symptoms of occult GI bleeding, mange—

A

trial iron supplementation and observe. if no response, pursue a small bowel source

58
Q

if patient greater than 60 and symptomatic or less than 60, manage…

A

pursue evaluation of small bowel

59
Q

occult Gi bleeding- STOP

A

nsaids, asa, clopidogrel

Surgery/ER Fall 2013 (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions