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GI_EB > GI bleeding > Flashcards

GI bleeding Flashcards

1
Q

_______ is the most common emergency of the GI tract

A

GI bleeding

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2
Q

Mortality from GI bleed is affected strongly by the patient’s _____ factors

A

comorbid

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3
Q

What should be the first step in the approach to a patient with a GI bleed

A

assess and stabilize hemodynamic status

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4
Q

Melena is strongly suggestive of _______ bleeding

A

upper

rarely right colon

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5
Q

Hematemesis is strongly suggestive of _____ bleeding

A

upper GI

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6
Q

Hematochezia is suggestive of ______ bleeding

A

lower GI

very brisk upper GI

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7
Q

What is the purpose of NG lavage?

A

assess for upper GI bleed
+ for blood- definitely an upper GI bleed
- for blood- cannot definitively rule out upper GI bleed

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8
Q

There is evidence to support earlier transfusion of blood in _______ patients with a GI bleed

A

elderly

coronary artery diseaes

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9
Q

______ is used to reverse blood thinning agents like warfarin and normalize the PT/INR more rapidly than Vitamin K

A

FFP

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10
Q

How do you interpret a finding of increased frequency of stools in a patient with suspected GI beed

A

increased frequency= more active bleeding

blood is cathartic

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11
Q

Chronic ______ increases risk for gastritis, gastric ulcers, duodenal ulcers

A

NSAID

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12
Q

If H&P of a patient with suspected GI bleed reveals underlying liver disease, there is increased concern for _______

A

variceal bleeding, portal hypertension

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13
Q

In patients with a history of AAA repair, there is increased concern for ______

A

aortoenteric fistula

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14
Q

Elevated _______ ratio may indicate an upper GI source of bleeding. Why?

A

BUN:Cr

BUN rises due to the breakdown of blood proteins to urea by intestinal bacteria which is then absorbed

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15
Q

_______ may not accurately reflect blood loss if measured acutely after onset of bleeding

A

hgb/hct

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16
Q

Iron deficiency anemia may indicate:

A

chronic GI bleed

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17
Q

Upper GI bleed is defined as proximal to the:

A

ligament of Trietz

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18
Q

List adverse clinical prognostic factors for GI bleeds

A 
shock
varices or cancer as cause of bleeding
comorbid disease
older age
onset in hospital
recurrent bleeding
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19
Q

List adverse endoscopic prognostic factors

A

active bleeding
bleeding from varices
visible vessel
large ulcer

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20
Q

The more units of blood that must be transfused, the greater the _____

A

mortality

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21
Q

The _______ travels right behind the duodenal bulb, so an ulcer in the duodenal bulb can erode and cause major bleeding

A

gastroduodenal artery

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22
Q

What is a Mallory-Weiss tear?

A

tear and GEJ

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23
Q

What is the classic presentation of a Mallory-Weiss tear?

A

history of recurrent retching prior to development of hematemesis

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24
Q

Most Mallory- Weiss tears occur on the _____ side

A

gastric

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25
Q

Describe course and treatment of Mallory-Weiss tears

A
  • bleeding usually stops spontaneously

- treat with hemoclips, injection of epinephrine, observation

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26
Q

In _______, irritation of the squamous epithelium leads to erosion and ulceration

A

esophagitis

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27
Q

List causes of esophagitis

A

reflux
radiation
Candida, CMV
pills/ meds

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28
Q

What is treatment for GI bleeds due to esophagitis?

A

acid suppression
stop offending medications
treat infection

29
Q

How does esophageal cancer cause bleeding?

A

bleeding can occur from primary as well as metastatic malignancies which ulcerate

30
Q

In esophageal cancer there is often a history of _______ before bleeding occurs

A

dysphagia to solids

31
Q

What is treatment for bleeds in esophageal cancer?

A

surgical
epinephrine
hemoclips

32
Q

_________ can cause life threatening bleeding

A

esophageal varices
distended veins beneath the esophageal mucosa that result from increased portal pressure due to cirrhosis or portal vein thrombosis

33
Q

How is active bleeding from esophageal varices treated?

A

band ligation
sclerotherapy
octreotide

34
Q

What temporary procedure can be done for active bleeding from esophageal varices that have not been controlled by band ligation or slcerosants, until more definitive therapy can be performed?

A

Sengstaken blakemore tube

definitive therapy is TIPS

35
Q

List possible etiologies of gastric ulcers

A

NSAIDs
H pylori
malignancy

36
Q

List treatments of gastric ulcers

A 
hemoclips
thermal-coaptiv therapy
bicap cautery
epinephrine injection
acid suppression
37
Q

In cases of gastric ulcers, you should get biopsies to assess for ______ and test for and treat ______

A

malignancy

H pylori

38
Q

List the stigmata of bleeding for gastric ulcers in order of most likely to rebleed

A 
active bleeding
non bleeding visible vessel
clot
dot
clean base
39
Q

_______ can reduce rebleeding, surgery, and death in patients with stigmata of bleeding in gastric ulcers

A

omeprazole

PPIs are good but not H2 blockers

40
Q

_______ is often caused by alcohol, NSAIDs, or H pylori and bleeding is usually minor

A

gastritis

41
Q

Define portal gastrophathy

A

vascular congestion of the stomach lining from increased portal pressure
- bleeding can be chronic as well as acute

42
Q

What is a Dieulafoy’s vessel?

A

abnormally large submucosal artery that can rupture and bleed, surrounded by normal mucosa

  • moderate to severe bleed
  • majority occur in the stomach
43
Q

What is treatment for a Dieulafoy’s vessel?

A

hemoclips, epinephrine injection, surgery, angioembolization

44
Q

What is duodenitis?

A

irritation of the duodenal mucosa, most often due to NSAIDs, but can also be caused by bile acids
- mostly chronic bleeding, but can be acute

45
Q

How is duodenitis treated?

A

Eradicate H pylori
stop NSAIDs
cholestyramine for bile acids

46
Q

What are common causes of duodenal ulcers?

A

NSAIDs, H pylori

47
Q

How are duodenal ulcers treated?

A

Hemoclip, cautery, epinephrine injection, surgery

48
Q

What is a serious complication of duodenal ulcers?

A

erosion into gastroduodenal artery

49
Q

What is an aortoenteric fistula?

A

communication between the aorta and the GI tract

  • 75% occur in the third portion of the duodenum
  • usually develop after AAA graft repair
50
Q

_______ are angioectasias that can occur anywhere in the GI tract but are most common in the small intestine

A

arteriovenous malformations

51
Q

What are AVMs associated with?

A

chronic renal failure
aortic stenosis
radiation

can be acute or chronic bleeding

52
Q

What is treatment for AVMs

A

argon plasma coagulation

53
Q

What steps are important to prevent recurrence of upper GI bleeding

A

eradicate H pylori
acid suppression
avoid NSAIDs
surgery- Billroth I or II

54
Q

Lower GI bleeding often presents with _______

A

hematochezia

55
Q

What is diverticulosis?

A

small pouches in the colon that bulge outward at weak spots in the colon wall, can bleed

56
Q

What is the normal course of bleeding with diverticulosis?

A

spontaneously stops in 75% of people

57
Q

How is diverticulosis localized?

A

tagged RBC scan

58
Q

How is diverticulosis treated?

A

endoscopy is difficult, use epi and hemoclips, angiography with embolization
surgery- hemicolectomy

59
Q

______ usually presents with bloody diarrhea and can have a variety of underlying causes

A

colitis

60
Q

List causes of colitis

A

Crohn’s, ulcerative
infectious, C diff
Ischemic

61
Q

How is bleeding due to colitis treated?

A

treat underlying cause

62
Q

AVMs can be found in the colon and are treated with _______

A

argon plasma coagulation

stop anticoagulation

63
Q

List signs and symptoms of colon cancer

A 
occult GI bleed or hematochezia
iron deficiency anemia
abdominal pain or masses
weight loss
change in caliber of stool
64
Q

What is a common history at presentation with hemorrhoids?

A

recent constipation with straining and then passage of brown stool with bright red blood

65
Q

What is treatment for hemorrhoids?

A

observation, stool softeners, banding if repeat bleeding

66
Q

What is evidence for occult bleeding?

A

iron deficiency anemia and/or recurrent guaiac positive

67
Q

The focus of the workup for occult bleeding is detection of _______

A

colorectal cancer

68
Q

What is the most common cause of obscure bleeding?

A

AVMs/ angioectasias

69
Q

What techniques can be used to evaluate the small intestine in the workup of obscure/ occult bleeding?

A

Push Enteroscopy: using a enteroscope for an upper endoscope and pushing as far as possible into the small intestine

  • Double balloon enteroscopy
  • capsule endoscopy
  • small bowel follow through x-rays
  • CT enteroclysis: double contrast imaging of the small bowel

GI_EB (39 decks)

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