GI Bleeding Flashcards
Bleeding is more common in which inflammatory bowel disease?
More common in UC than Crohns
Area of lower GI bleds
Distal to ligament of treitz
(jejunum to anus)
Three symptoms of anorectal abscess
Perianal pain
Fever
Bright red blood
Which condition is associated with “watermelon stomach”?
Gastric antral vascular ectasia
Which patients are most likely to have lower GI bleeds caused by angiodysplasia?
Elderly
Angiodysplasia = thin walled vessels, collagen degradation in elderly
Most common causes of peptic ulcer disease
US = NSAIDs
World = H. pylori
First test normally done in assessment of a GI bleed
Endoscopy
Most common cause of upper GI bleeds
Peptic ulcer disease
Three factors that make post-polypectomy bleeding more likely
Elderly
Polyp removed was larger than 1cm
Polyp was in cecum
Symptoms in diverticulosis caused by lower GI bleeds
Painless, large bloody stools
Diagnostic test of choice in an active GI bleed
CT angiography
Gold standard treatment for perianal abscess
Incision and drainage
Gold standard for diagnosis of peptic ulcer disease
EGD - endogastrodudodenoscopy
Location of Dieulafoy lesions
Upper stomach
Condition causing longitudinal lacerations of esophageal mucosa at gastrointestinal junction
Mallory-Weiss tears
Four risk factors for diverticulosis
Low fiber diet leading to constipation
NSAIDs/aspirin
Ischemic heart disease
Hypertension
Most common location of rectal fissures
Posterior anal canal
Treatment for proctitis
Steroid enemas
Name of procedure to shunt blood from portal vein to avoid the liver
TIPS
Trans-jugular intrahepatic portosystemic shunt
This painful condition is referred to as a “stroke of the colon”
Ischemic colitis
Rectal damage from radiation therapy can cause lower GI bleeds. This condition is known as …
Proctitis
How long does bleeding show up after a polypectomy?
7-10 days
Severe anal pain with passing of a bright red bloody stool in a patient with a history of constipation might suggest …
Rectal fissure
CT angiography can only be used to diagnose these GI bleeds
Active GI bleeds
Most common cause of occult GI bleeding
Inflammation
Symptoms of proctitis
Lower GI bleed 9 months to a year after radiation therapy
Symptoms in angiodysplasia caused lower GI bleeds
Intermittent, low grade bleeding
Symptoms in variceal bleeds
Sudden overt bleeding
Large volume hematemesis
Cause of Dieulafoy lesions
Large-caliber tortuous artery in stomach wall that erodes and bleeds
Most common location for angiodysplasia in lower GI bleeds
Cecum or ascending colon
Treatments for a hemodynamically unstable GI bleed
Large bore IV for fluid resuscitation with normal saline or lactated ringer
Transfusion for active, brisk bleeding
- Keep Hgb above 7
Landmark used to distinguish upper from lower GI bleeds
Ligament of Treitz
Bright red blood on the outside of stool is suggestive of
Hemorrhoids
Cause of Mallory-Weiss tears
Retching/vomiting
Common in alcoholics
Two common symptoms with upper GI bleeds
Melena
Hematemesis
Medications for a GI bleed in a patient with a history of liver cirrohsis
IV ceftriaxone or ciprofloxacin
Octreotide to lower splanchnic blood flow and portal bp in varices
Cause of Cameron lesions
Linear erosions due to hiatal hernia
Describe “melena”
Black, tarry stool
Cause of variceal bleeds
Dilation of small (distal) esophageal veins due to portal hypertension (alcoholism)
Two most common causes of lower GI bleeds
Diverticulosis (most common)
Angiodysplasia
Location of diverticulosis caused lower GI bleeds
Descending/left colon
Treatment of variceal bleeds
Urgent IV fluids and transfusions
EG banding
Lower portal BP with non-selective beta-blocker
Biggest risk factor for anorectal abscess
Diabetes
(also IBD, HTN, HIV, heme disorders)
Reason for increased BUN/Cr in upper GI bleeds
From digestion of protein in red blood cells
Signs in upper GI bleeds, in order
First sign: tachycardia
15% blood loss: orthostatic hypotension
40% blood loss: resting hypotension
New iron deficiency anemia in a patient aged 50+ should be screened for this disease
Colorectal cancer
