Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CSI- Winter > GI Bleeding > Flashcards

GI Bleeding Flashcards

1
Q

Hematemesis

A

bright red blood in vomit, or coffee ground type material

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Melena

A

black, tar like stool

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Hematochezia

A

BRBPR (bright red blood per rectum), usually lower, but if

massive upper GIB, can have this

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Esophagus spinal level

A

T2-T8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Spinal level for Upper GI Tract

Stomach, Liver, Gallbladder, Spleen, Portions of Pancreas and Duodendum

A

T5-T9, Greater Splanchnic Nerve Celiac Ganglion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Spinal level for Middle GI Tract

Portions of Pancreas and Duodenum, Jejunum, Ileum, Ascending Colon, and 2/3 of Transverse Colon

A

T10-T11, Lesser Splanchnic Nerve Superior Mesenteric Ganglion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Lower GI Tract

Distal 1/3 of Transverse Colon, Descending Colon and Sigmoid Colon, Rectum

A

T12-L2, Least Splanchnic Verse Inferior Mesenteric Ganglion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Acute upper GI bleed can be from

A
  • Peptic Ulcer Disease (H pylori)
  • Portal Hypertension: 10-20% of cases; can be massive due to esophageal or gastric varices; pressures in portal system, draining into liver, esophageal varices are very risky if they start bleeding
  • Mallory Weiss tear
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Initial step for acute GI bleed

A
  • NG tube? Gastric Lavage?
  • Rectal?
  • Hemodynamic Stabilization
  • -BP Systolic 100 response to acute
  • -blood loss, first vital sign of change
  • HCT takes 24-72 hours to equilibrate
  • Two large 18 gauge IV’s
  • Type and Screen, CBC, INR/PT/PTT, CMP
  • 0.9% NS until blood ready, if needed can use O – blood universal donor
  • ICU? Central line?
  • Give bolus of IV saline until you can see what hemoglobin levels are
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Goal of hemoglobin?

A

New guidelines:

  • 7 is threshold now, unless cardiac history then consider goal of >9 (if having MI; want to increase oxygenation to cardiac muscle)
  • Platelets > 50,000

-Warfarin? INR high? Give FFP
Note: massive transfusion can have dilutional effect on INR/PT/PTT, consider 1 unit of FFP for each 5 units of PRBC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Uremia? End Stage Renal Disease patient? Consider _________

A

DDAVP (desmopressin acetate, synthetic ADH)

-in pts with uremia, platelets are there but don’t stick together well bc of uremia, DDAVP helps promote platelet adhesion, makes them sticky again

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

History items to consider during acute upper GI bleed

A
  • Aspirin? Cant reverse- takes 10-14 days to get our of your system (Clopridogrel and ASA- platelets are irreversibly inhibited)
  • NSAIDS? Cant reverse
  • NOAC? Novel oral anticoagulation
  • Cirrhosis? Think esophageal varices

-WHEN WAS THE LAST DOSE TAKEN?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Role of upper endoscopy in acute upper GI bleed

A
  • Stabilize patient first hemodynamically
  • Cautery, injection, endoclips
  • Banding varices
  • Bleeding ulcer or vessel: vessel they can clip, clips fall off on their own
  • Put rubber bands on esophageal varices to prevent them from bleeding/rupturing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Pharmacologic therapy for acute upper GI bleed

A

-IV PPI (bolus then drip for 72 hours)
-Consider PO PPI if low risk features
-Octreotide: gastric varices in liver patients, prevent them from bleeding worse if they have a small bleed- given IV
Patient’s with esophageal or gastric varices, liver disease, portal HTN; Reduces splanchnic blood flow and portal blood pressures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Long term side effects with PPI use

A
  • Potential decrease in non heme iron absorption with PPI has not been well studied
  • No good evidence to support PPI use affecting bone density or osteoporosis related fractures
  • ~50 cases of hypomagnesemia associated with PPI use
  • FDA recommended consider checking magnesium level before starting long term PPI therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Acute lower GI bleed

A
  • Hematochezia
  • 10% due to upper source
  • Lower definition: below ligament of Treitz
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Causes of acute lower GI bleed

A
  • Diverticulosis (can erode a blood vessel and bleed; acute, painless, large volume possible)
  • Angioectasia: more common in CKD/ESRD patients
  • Neoplasms
  • IBD
  • Anorectal disease (hemorrhoids, fissures)
  • Ischemic Colitis (older pt, nonocclusive ischemia, usually self limited)
  • Radiation induced proctitis (can irritate mucosa)
18
Q

Test for acute lower GI bleed

A

-Exclude upper GIB (NGT, lavage)
-Rectal Exam
-Colonoscopy or sigmoidoscopy
(Prep with GoLYTELY 3.8L)
-NM PRBC Scan (if positive, next step is angiography; Localization is poor, and

19
Q

Crohn’s vs UC: Site of origin

A

C- terminal ileum

UC- rectum

20
Q

Crohn’s vs UC: Pattern of progression

A

C- Skip lesions/irregular

UC- proximally contiguous

21
Q

Crohn’s vs UC: Thickness of inflammation

A

C- transmural (across wall)

UC- submucosa or mucosa

22
Q

Crohn’s vs UC: Symptoms

A

C- crampy abdominal pain

UC- bloody diarrhea

23
Q

Crohn’s vs UC: Complications

A

C- fistulas, abscess, obstruction

UC- hemorrhage, toxic megacolon

24
Q

Crohn’s vs UC: Radiographic findings

A

C- string sign on brain X-ray

UC- lead pipe colon on barium X-ray

25
Q

Crohn’s vs UC: Risk of colon cancer

A

C- slight increase

UC- marked increase

26
Q

Crohn’s vs UC: Surgery

A

C- for complications such as stricture

UC- curative (take out whole colon to rule out cancer, use colostomy bag)

27
Q

Transfusion in acute upper GI bleed

A
  • Restrictive strategy group threshold of 7 g/dl (Goal 7-9)
  • Liberal group threshold of 9 g/dl (Goal 9-11)
  • Mortality at 45 days lower in restrictive strategy group 23/444 vs. 41/445
  • Subgroup with cirrhosis, risk of death was lower in restrictive strategy group 15/139 vs. 25/138
28
Q

New anticoagulants in GI bleed

A

Pradaxa – dabigatran
Xarelto – rivaroxaban
Eliquis - apixaban

-metabolized in kidney, warfarin is in liver
-Expensive, don’t have to get INR checked regularly
Coumadin, Warfarin take 72 hours to become activated and work

  • These meds start working within hours- advantage if you are already bleeding- within 24-48 hrs they are out of your system
  • Direct factor 10a inhibitors (3 of them)
  • Block thrombin (1 of them)
29
Q

see slide 26

A

see slide 26

30
Q

New anticoagulant risks

A
  • Lower risk of hemorrhagic stroke brain bleed

- Higher risk of GI bleed

31
Q

When to resume Warfarin after GI bleed

A
  • GIB defined by HGB drop by 2 grams, visible bleeding, or positive endoscopic evaluation
  • Restarting warfarin after 7 days was NOT associated with increased risk of GIB, but was associated with decreased risk of mortality and thromboembolism compared with resuming after 30 days of interruption.
32
Q

Put older people on anti platelet therapy to prevent

A

them from bleeding (on steroids, NSAIDS, put them on pentoprazol to prevent a bleeding ulcer, even with the risk of C diff)

33
Q

INR goal of 2-2.5 is recommended for

A

-Combination of aspirin and heparin/LMWH/warfarin or clopidogrel

34
Q

Use of low dose aspirin for cardiovascular prophylaxis associated with

A

2-4 fold increase in upper gastrointestinal events

-AHA recommends low dose aspirin in patient with 10 year cardiovascular risk > or = 10%
-Full 325 ASA for prevention- very high bleeding risk- don’t need to use this
81 mg does just as good and has LOWER bleeding risk

35
Q

Gastric ulcer indication

A

Greater pain with meals

36
Q

Duodenal ulcer indication

A

Decreased pain with meals

37
Q

Ischemic colitis indication

A

post-prandial abdominal pain, older patient, hematochezia

38
Q

H2 blockers

A

famotidine, ranitidine – Block H2 receptors of parietal cells

39
Q

PPIs

A

omeprazole, pantoprazole

  • Inhibit H+/K+ ATPase in parietal cells
  • Low magnesium levels possible with long term use, higher risk of C diff
40
Q

Magnesium

A

Makes you go, take for constipation

41
Q

Aluminium

A

minimum amount of feces, take for diarrhea

42
Q

Osmotic laxatives

A

PEG, lactulose

CSI- Winter (44 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions