GI bleeding Flashcards
What is the differentiation point for the upper and lower GI bleeding?
Ligament of Trietz (LoT) is at the duodenojejunal junction
-Upper GI bleed
From a source above the LoT
-Lower GI bleed
From a source below the LoT
Presentation of Upper GI bleeding
4
- Hematemesis
- Blood or coffee grounds detected during nasogastric lavage
- Melena
- BUN to serum creatinine ratio greater than 30
Presentation of Lower GI bleeding
3
- Blood clots in the stool
- Red blood that is mixed with solid brown stool
- Dripping of blood into the toilet after a bowel movement
- Hematemesis will look like what?
- Melena can occur with just how much blood loss in the upper GI tract?
- Hematochezia is what color?
- Hematochezia is generally caused by what but can also be caused by?
- Red or brown flakes like coffee grounds
- 50-100 mL of blood
- Red or maroon colored stool
- Generally from a lower GI source but can occur with a loss of more than 1000 mL of blood in the upper GI tract
What causes coffee-ground emesis?
Blood sitting in the stomach acid causes the iron to oxidize resulting in the appearance of coffee ground like flakes
Describe the following for Upper GI bleeds and also for Lower GI bleeds: 1. Severity? 2. Site? 3. Presentation? Upper- 3 Lower -1 4. Nasogastric lavage? 5. Bowel sounds? 6. BUN:Creat ratio?
Upper GI Bleed (2/3 of cases of GIB) 1. More likely to have significant bleeding 2. Above the Ligament of Trietz 3. -Hematemesis, -melena, -Hematochezia with massive UGI of > 1000 mL 4. Blood 5. Hyperactive 6. > 30:1
Lower GI Bleed
- Less likely to present with shock or require transfusion
- Below the Ligament of Trietz
- Hematochezia
- Clear fluid
- Normal
- Normal
Review: Where does BUN come from?
5 steps
- When protein is used for energy the carbon is cleaved from the amino acid and leaves behind a Nitrogren.
- The N takes up 3 H+ to form NH3+ which is ammonia.
- The ammonia (NH3+) is then processed through the liver to become urea.
- When the urea enters the blood stream it is called the blood urea nitrogren.
- The blood urea nitrogren is then excreted by the kidney
BUN increases when protein is broken down and more ammonia forms
Examples? 6
- Burns
- Tetracycline
3 Steroids - Fever
- Catabolic state
- Upper GI bleeding
How does Upper GI bleeding cause increased BUN?
(breakdown of the hemoglobin protein by the stomach acid, enzymes)
Etiology of Upper GI bleeds?
(in order of prevelance)
8
- Peptic ulcer dz 50%
- Portal HTN 20%
- Mallory-Weiss Tear 10%
- Vascular anomalies 7%
- Others 6%
- Erosive Gastritis 5%
- Erosive esophagitis 1%
- Gastric neoplams 1%
- Portal HTN is most commonly caused by?
2. Results in formation of what? 3
- Most common cause is cirrhosis
- Results in formation of
- esophageal,
- gastric and
- duodenal varices that can rupture
- What is a mallory weiss tear?
- Most often caused by?
- Other causes? 6
- Laceration of the gastroesophageal junction
- Often report a history of retching which may be due to heavy drinking
- Seizure,
- childbirth,
- coughing,
- straining,
- defecation,
- weight lifting
Vascular anomalies that cause UGI bleeding?
2
- Angiodysplasia
2. Telangectasias
- Angiodysplasia are what?
2. Telangectasias associated with what?
- Small AV malformations
2. Associated with connective tissue disease like CREST syndrome and HHT
- Erosive gastritis is usually described as what kind of bleeding?
- Erosive esophagitis secondary to what?
- Usually superficial bleeding that does not lead to acute significant blood loss
- Secondary to chronic reflux