GI Bleeding Flashcards
Hematochezia
Passage of bright red or maroon blood from the rectum
usually means Lower GI bleed
—> if severe systemic instability
Melena
black, tarry stools
which is the most common reason for upper GI bleeding?
ulcers then varices then erosions
Coffee ground stuff in vomiting is seen in
upper GI bleeding (above ligament of treitz).
Is melena is seen in upper or lower GI bleeds?
BOTH- Blood has been present in the GI tract for a while to allow it to have changed from red to black - recent bleed or a remote bleed
High BUN means
UGIB (hematemesis and melena)
Clean based ulcer have low risk of re-bleeding
Flat spot or pigmentation ulcer has a greater risk of re-bleeding
Adherent clot will re-bleed. You treat it by taking off the clot
A visible vessel on an ulcer will rebleed and require endoscopy
Active bleed
needs to be controlled w. PPI
PPIs work by keeping the pH inside the stomach as neutral
keeping the pH inside the stomach as neutral
Small bowel bleeding result from
are vascular AVM ectasias, tumors, and NSAID-induced erosions and ulcers
KIDS—Meckel’s diverticulum
Colonic sources of GI bleeding
If they are hemodynamically stable–> hemorrhoids and anal fissures
If the patient is not hemodynamically stable then it is due to diverticular bleed (a massive bleed that stops spontaneously) then AV malformations
Adults: IBD
Kids: juvenile polyps
To control LGIB, if patient is hemodynamically unstable you
do an endoscopy
To control LGIB, if patient is hemodynamically stable you
do colonoscopy
Jaundice - if you find bilirubin in urine suggests liver dysfunction and it is conjugated bilirubin and now liver can’t get it out of liver.–unless the patient has glomerular disease
BILIRUBINEMIA -
elevated serum bilirubin suggests Unconjugated Bilirubin
—increased production from trauma, blood transfusion
—decreased uptake into the liver
—decreased conjugation (Gilbert) v. Crigler Najjar
—conjugated Bilirubin not being excreted into bile canaliculus–> Dubin Johnson, Rotor syndrome
