GI Bleeding Flashcards
Define Upper GI Bleed
Bleed from a source above the Ligament of Trietz
Define Lower GI Bleed
Bleed from a source below the Ligament of Trietz
Presentation of Upper GI Bleeding
Hematemesis
Blood/coffee grounds detected during nasogastric lavage
Melena
BUN to creatinine ratio >30
Presentation of Lower GI Bleeding
Blood clots in stool
Red blood mixed with solid brown stool
Dripping of blood into the toilet after a bowel movement
Define Hematemesis
Red or brown flakes like coffee grounds
What is the minimum amount of blood to be considered melon?
50-100 mL
Define Hematochezia
Red or maroon colored stool
Usually lower GI
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
Features of an Upper GI Bleed
More significant bleeding Above the LoT Presentation: hematemesis, melena, hematochezia Nasogastric lavage: blood Hyperactive bowel sounds BUN:Creat >30:1
Features of a Lower GI Bleed
Less likely shock or require transfusion Below the LoT Presentation: Hematochezia Nasogastric lavage: Clear fluid Normal bowel sounds Normal BUN:Creat
What Produces Ammonia?
Burns Tetracycline Steroids Fever Catabolic state Upper GI bleeding
Etiologies of Upper GI Bleeds
PUD Portal HTN Mallord-Weiss tears Vascular anomalies Erosive gastritis Erosive esophagitis Gastric neoplasm Aortoenteric fistula Hepatic tumor Angioma Penetrating trauma Pancreatic malignancy
What results because of portal HTN?
Esophageal, gastric, and duodenal varies that can rupture
Most Common Cause of Portal HTN
Cirrhosis
Etiologies of Mallory-Weiss Tears
Retching Seizure Childbirth Coughing Straining Defecation Weight lifting
Define Angiodysplasia
Small AV malformations
What is telangectasis associated with?
CREST syndrome
HHT: hereditary hemorrhagic telangiectasia
What is erosive esophagitis secondary to?
Chronic reflux
Etiology of Lower GI Bleeding in Patients
Infectious colitis
Anorectal disease
IBD
Etiology of Lower GI Bleeding in Patients >50
Diverticulosis Agioectasias Malignancy Ischemia Radiation induced proctitis Acute infectious colitis
Define Diverticulosis
Acute, painless, large volume maroon or bright red hematochezia
Define Angioectasias
Painless bleeding in the upper or lower GI tract
Main Anorectal Disease in Lower GI Bleeding
Hemorrhoids
Fissures
When do you usually see ischemic colitis?
Older patients with atherosclerotic disease
Young patients with long distance running
Initial Management of GI Bleeding
Stabilization
Blood replacement
GI consult for upper/lower endoscopy
Severe Bleeding SBP & HR
SBP: 100
Moderate Bleeding SBP & HR
SBP: >100 mmHg
HR >100
Minor Bleeding SBP & HR
Normal HR & BP
Labs in Assessing GI Bleeding
CBC
PT/INR
CMP
Type/screen
Stabilization of a GI Bleed Patient
2 large bore IV's NS or LR Nasogastric tube +/- IV PPI for upper GI IV octreotide or somatostatin for portal HTN
Transfusion for GI Bleeds
Target Hgb: 7-10 g/dL Hgb increase per unit blood: 1 g/dL 1 unit FFP for 5 units PRBCs Transfuse plates if 1.8 Uremic puts may benefit from DDAVP
Treatment of GI Bleeds
Surgical repair
Intra-arterial embolization
Decompression of the portal vein with shunt placement if varies not manageable
How long does it take for the HCT to be accurate for blood volume?
24 hours
What type of anemia will occur with acute blood loss?
Normocytic
What type of anemia will occur with chronic blood loss?
Microcytic
