GI Bleeding Flashcards
What is the first priority in evaluation of someone with a GI bleed?
assessing/stabilizing ABC
airway
breathing
circulation
pertinent labs: CBC, electrolyte, LFTs, PT and PPT, type and cross are commonly assessed
later assess risk factors and find source of bleeding: endoscopy, colonoscopy, angiography etc.
What are risk factors for acute GI bleed?
NSAID use
etiologies are often age specific
underlying liver disease
hx of diverticulosis or AAA repair
If a patient with GI bleed presents requiring fluid recitation, what is important to remember?
2 large bore IVs or a central line to administer blood products or fluids
blood type and cross match may also be prudent
An elevated BUN: Cr ratio may mean what regarding GI bleed?
may suggest an upper GI bleed (BUN rises due to the breakdown of blood proteins to urea by intestinal bacteria which is then reabsorbed)
What is the line of demarcation between upper and lower GI bleeds?
ligament of Treitz
What are the top 3 causes of upper GI bleed?
duodenal ulcer, gastric ulcer or varicies
What are adverse clinical prognostic factors of UGI bleed?
shock, red blood in stool varicieal or cancerous cause of bleeding older age onset in the hospital recurrent bleeding
endoscope: active bleeding, bleeding from varies, large ulcer, visible vessel, dangerous location of ulcer
How does units transfused have prognostic value?
over 6 units since admission, prognosis starts to deteriorate
co-morbid diseases also contribute to poor prognosis
What is a Mallory Weiss tear? What is a common accompanying hx? How do you treat?
tear at the gastroesophageal junction, often accompanied by a history of recurrent retching prior to development
bleeding can stop spontaneosly, treat with hemoclips, injection of epineprine and observation
What are common causes of esophagitis leading to erosion/ulceration and how is it treated?
reflux, radiation, Candida, CMV, erosive effects of pills in the esophagus
tx. with acid suppression, stop offending meds, treat infection
What other symptom may occur leading up to bleed caused by esophageal cancer?
history of dysphagia to solid foods
tx is often surgical, slow bleeding with injection of pi or hemoclips
What is the purpose of a Sengstaken blakemore tube?
two balloon system that is inflated and then braced with traction to hold pressure against the esophagus
Order the different characteristics of ulcers by the severity of bleeding (visible cells, spurting, oozing, adherent clot)
active bleed, non-bleeding visible vessel, clot, dot, clean base
bleeding risk decreased with IV PPIs
Characterize the bleeding due to gastritis and portal gastropathy.
gastritis: bleeding is usually minor
portal gastrophathy can be chronic as well as acute
What is a Dieulafoy’s vessel?
abnormally large submucosal artery that can rupture and cause a moderate to severe bleed (tx. with hemoclips, epi injection, surgery or angioembolization)
What clinical context is likely in the case of a bleed caused by aortoenteric fistula (pt. hx, location of bleed etc.)
75% occur in the third portion of the duodenum
most commonly in the situation of graft repair
** 50% will have a herald bleed that stops spontaneously hours to days before the massive bleed
tx is usually with surgery- TX required VERY QUICKLY
How are AVMs treated and what conditions are they commonly associated with?
AVMs are associated with chronic renal failure, aortic stenosis, and radiation therapy
can be a source of acute and chronic bleeding, treated with argon plasma coagulation
_____ accounts for 30-50% of all cases of lower GI bleeding, bleeding stops spontaneously in about 75% of patients.
Diverticulosis
What diagnostic tool is used specifically to find the bleed in diverticulosis?
tagged RBC scan to localize bleeding because endoscopy is often difficult to use finding a single tic that is bleeding
T/F Colitis is a common cause of major lower gastrointestinal hemorrhage.
False: overall, major hemorrhage is uncommon for Crohn’s, infectious, C. diff, Ulcerative, and Ischemic colitis.
What symptoms usually accompany hemorrhoids as the cause of lower GI bleed?
hx. of recent constipation with straining and passage of brown stool with bright red blood, digital rectal exam will be very helpful in dx.
use observation and stool softners for repeat bleeding
Contrast occult and obscure bleeding.
occult: patient not aware of bleeding (often found by anemia or recurrent guaiac + stool) should be worked up to exclude colon cancer
obscure: bleeding apparent to patient but location of bleed is not readily clear
Describe the work up (type of imaging) useful in occult/obscure bleeding.
- repeat EGD and colonoscopy
- further evaluation of the small intestine by push enteroscopy, double balloon eneteroscopy, capsule endoscopy, sm. bowel follow through X-rays, CT enteroclysis
- active bleed: tagged RBC scan
