GI Bleeding Flashcards
Hematochezia =
stools w/ obvious blood (bright red, maroon, currant jelly)
Loss >40% blood volume will cause ____
supine hypotension
Loss ~15% blood volume will cause ____
orthostatic drop in SBP > 20 mmHg +/- increase HR of >20 bpm
T/F: Hemoccult/gastroccult is helpful in diagnosing an acute GI bleed.
False. Not helpful acutely
T/F: Hemoglobin/hematocrit is NOT reliable in acute bleed
True
_____mL of blood in UGI tract causes melena
50-100 mL
BUN/creatinine >20 → (UGI/LGI) source
UGI
Blood clots in stool → (UGI/LGI) source
LGI
T/F: Varices are painful
False. Ulcers are painful
Secondary Aortoenteric Fistula is most common when?
Post repair of aortic aneurysm
Herald bleed = a warning sign of what?
exsanguinating hemorrhage if AEF is not identified in timely fashion
Which of the following is NOT a cause of massive bleeding? A. Diverticular bleed B. Hemorrhoids C. Ischemia D. Arteriovenous malformation
B. Hemorrhoids are chronic, less dramatic bleeding. So are colon cancers and IBD
History of diarrhea suggests ____
IBD
“Wipe” bleeding, anal discomfort suggests ____
hemorrhoids
Most common anomaly of GI tract
Meckel’s diverticulum
Protrusion of mucosa and submucosa through weak spots in circular muscle =
Diverticula
Occult GI bleeding is detected by ____ (2)
iron deficiency or + fecal occult blood test
Occult GI bleeding is typical of ____
early colon cancers
Overt or occult bleed that persists or recurs after initial negative endoscopic/colonoscopic evaluation =
Approach for evaluation?
Obscure GI bleeding
Confirm negative endoscopies → focus on potential small bowel source via video capsule endoscopy, deep enteroscopy, angiography, CT enterography
Which of the following is/are NOT a characteristic(s) of iron deficiency in adults?
A. Iron supplementation is sufficient approach
B. Decreased ferritin
C. Low MCV
D. Decreased transferrin
A. MUST work up for occult blood loss
D. compensatory increase in transferrin/TIBC
Treatment for acute variceal bleeding
IV octreotide
Laser, argon plasma coagulators, injection of epinephrine, ligation or gluing of varices are treatment options for ____
superficial mucosal lesion
T/F: Surgery for ulcer bleeding is a first line option of treatment.
False. Only for failure of nonsurgical RX for ulcer bleeding
T/F: Urgent colonoscopy in LGI bleeding reduces mortality, hospital stay, transfusion requirements… etc.
False. Statement true for urgent UPPER endoscopy in UGI. Urgent colonoscopy in LGI bleeding not as helpful
T/F: If massive bleeding and can’t stabilize, perform an endoscopy to find out the source of the bleed.
False. Do NOT do endoscopy, consider alternatives.
Which of the following is TRUE about angiography?
A. REQUIRES active bleeding of at least 0.1 - 0.5 ml/min to identify bleeding site
B. Requires bowel prep
C. Procedure of choice in hemodynamically unstable pts
C
A. 0.5-1.0 ml/min
B. Does NOT require bowel prep
T/F: Angiography is more sensitive that tagged RBC scan.
False. RBC scan requires less active bleeding (0.1-0.5 ml/min vs 0.5-1.0 ml) than angiography
Which of the following is FALSE about the tagged RBC scan?
A. REQUIRES active bleeding of at least 0.1-0.5 ml/min
B. Useful in localizing bleeding site
C. Helpful for evaluating intermittent bleeding
D. Can re-image every few hours as needed
B. Difficult to localize.
Which of the following is NOT a cause of small bowel bleeding? A. Angioectasias B. IBD C. NSAID enteropathy D. Gastroantral vascular ectasia E. Meckel's diverticulum
D. GAVE is a cause of upper GI bleed.
Angioectasia = arteriovenous malformation (common in older pts)
Which of the following is NOT a cause of upper GI bleeding? A. Vascular ectasias B. Arterial venous malformation C. Dieulafoy's lesion D. Meckel's diverticulum
D. Meckel’s diverticulum is a cause of small bowel bleeding
