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EM - Exam 2 > GI Bleeding > Flashcards

GI Bleeding Flashcards

1
Q

Who is MC affected by GI bleeds?

A

Males and elderly

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2
Q

What is MC - upper or lower GI bleed?

A

Upper

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3
Q

Where does an upper GI bleed originate?

A

Proximal to ligament of Treitz

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4
Q

Where does a lower GI bleed originate?

A

Inferior to ligament of Treitz

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5
Q

Coffee ground hematemesis is suggestive of what type of GI bleed?

A

Upper

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6
Q

Melena is suggestive of what type of GI bleed?

A

Upper

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7
Q

ETOH is suggestive of what type of GI bleed?

A

Upper

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8
Q

Hematochezia is suggestive of what type of GI bleed?

A

Lower

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9
Q

Labs for GI bleed work up

A
  • Blood type and cross match (# of units)
  • CBC (H/H, platelets)
  • BUN
  • Coag (PT/PTT), troponin, EKG
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10
Q

X-rays in evaluation of GI bleed

A

Limited value

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11
Q

CT in evaluation of GI bleed

A
  • Poor localization of bleed site
  • Barium limits subsequent endoscopy or angiography
  • Useful if aortoenteric fistula suspected
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12
Q

Angiography in evaluation of GI bleed

A
  • Requires brisk bleeding rate to be diagnostic

- Can allow for embolization or vasoconstrictive injection hemostasis

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13
Q

Scintigraphy in evaluation of GI bleed

A
  • Nuclear scan

- More sensitive than angiography

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14
Q

Endoscopy/colonoscopy in evaluation of GI bleed

A
  • Can be diagnostic and therapeutic if site is amenable to cautery or vasoconstrictive meds
  • Limited visualization
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15
Q

Treatment of GI bleed

A
  • ABCs, cardiac monitoring, O2
  • IVF of at least 2L
  • Blood transfusion if necessary
  • NG tube and lavage maybe
  • Pantoprazole
  • Octreotide IV for varices or PUD
  • GI consult, Blakemore tube
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16
Q

When would NG tube and lavage be helpful in GI bleeds?

A
  • To determine origin of bleed
  • May assist w/nausea
  • Use w/caution in pts with known or suspected varices
17
Q

What findings are predictive of poor outcome of GI bleed?

A
  • Initial Hct under 30
  • Initial SBP under 100
  • Bright red blood in NG lavage
  • Hx of cirrhosis or current ascites
  • Hx of vomiting bright red blood
  • Use of anticoags

EM - Exam 2 (7 decks)

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