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GI > GI Bleeding > Flashcards

GI Bleeding Flashcards

1
Q

Define Upper GI Bleed

A

Bleed from a source above the Ligament of Trietz

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2
Q

Define Lower GI Bleed

A

Bleed from a source below the Ligament of Trietz

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3
Q

Presentation of Upper GI Bleeding

A

Hematemesis
Blood/coffee grounds detected during nasogastric lavage
Melena
BUN to creatinine ratio >30

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4
Q

Presentation of Lower GI Bleeding

A

Blood clots in stool
Red blood mixed with solid brown stool
Dripping of blood into the toilet after a bowel movement

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5
Q

Define Hematemesis

A

Red or brown flakes like coffee grounds

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6
Q

What is the minimum amount of blood to be considered melon?

A

50-100 mL

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7
Q

Define Hematochezia

A

Red or maroon colored stool

Usually lower GI

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8
Q

What causes coffee-ground emesis?

A

Blood sitting in the stomach acid causes the iron to oxidize resulting in the appearance of coffee ground like flakes

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9
Q

Features of an Upper GI Bleed

A 
More significant bleeding
Above the LoT
Presentation: hematemesis, melena, hematochezia
Nasogastric lavage: blood
Hyperactive bowel sounds
BUN:Creat >30:1
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10
Q

Features of a Lower GI Bleed

A 
Less likely shock or require transfusion
Below the LoT
Presentation: Hematochezia
Nasogastric lavage: Clear fluid
Normal bowel sounds
Normal BUN:Creat
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11
Q

What Produces Ammonia?

A 
Burns
Tetracycline
Steroids
Fever
Catabolic state
Upper GI bleeding
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12
Q

Etiologies of Upper GI Bleeds

A 
PUD
Portal HTN
Mallord-Weiss tears
Vascular anomalies
Erosive gastritis
Erosive esophagitis
Gastric neoplasm
Aortoenteric fistula
Hepatic tumor
Angioma
Penetrating trauma
Pancreatic malignancy
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13
Q

What results because of portal HTN?

A

Esophageal, gastric, and duodenal varies that can rupture

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14
Q

Most Common Cause of Portal HTN

A

Cirrhosis

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15
Q

Etiologies of Mallory-Weiss Tears

A 
Retching
Seizure
Childbirth
Coughing
Straining
Defecation
Weight lifting
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16
Q

Define Angiodysplasia

A

Small AV malformations

17
Q

What is telangectasis associated with?

A

CREST syndrome

HHT: hereditary hemorrhagic telangiectasia

18
Q

What is erosive esophagitis secondary to?

A

Chronic reflux

19
Q

Etiology of Lower GI Bleeding in Patients

A

Infectious colitis
Anorectal disease
IBD

20
Q

Etiology of Lower GI Bleeding in Patients >50

A 
Diverticulosis
Agioectasias
Malignancy
Ischemia
Radiation induced proctitis
Acute infectious colitis
21
Q

Define Diverticulosis

A

Acute, painless, large volume maroon or bright red hematochezia

22
Q

Define Angioectasias

A

Painless bleeding in the upper or lower GI tract

23
Q

Main Anorectal Disease in Lower GI Bleeding

A

Hemorrhoids

Fissures

24
Q

When do you usually see ischemic colitis?

A

Older patients with atherosclerotic disease

Young patients with long distance running

25
Q

Initial Management of GI Bleeding

A

Stabilization
Blood replacement
GI consult for upper/lower endoscopy

26
Q

Severe Bleeding SBP & HR

A

SBP: 100

27
Q

Moderate Bleeding SBP & HR

A

SBP: >100 mmHg

HR >100

28
Q

Minor Bleeding SBP & HR

A

Normal HR & BP

29
Q

Labs in Assessing GI Bleeding

A

CBC
PT/INR
CMP
Type/screen

30
Q

Stabilization of a GI Bleed Patient

A 
2 large bore IV's
NS or LR
Nasogastric tube +/-
IV PPI for upper GI
IV octreotide or somatostatin for portal HTN
31
Q

Transfusion for GI Bleeds

A 
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
32
Q

Treatment of GI Bleeds

A

Surgical repair
Intra-arterial embolization
Decompression of the portal vein with shunt placement if varies not manageable

33
Q

How long does it take for the HCT to be accurate for blood volume?

A

24 hours

34
Q

What type of anemia will occur with acute blood loss?

A

Normocytic

35
Q

What type of anemia will occur with chronic blood loss?

A

Microcytic

GI (20 decks)

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