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emergency medicine > gi bleeding > Flashcards

gi bleeding Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

define upper gi bleeding

A

hemorrhage from any source between the pharynx and teh ligament of treitz

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2
Q

characteristics of upper gi bleed

A

hematemesis and melena

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3
Q

causes of upper gi bleeding

A 
esophageal vaices
mallory-weiss tears
esophageal rupture
boerhaave's syndrome
bleeding gastric varices
angiodysplasia
cancer
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4
Q

in patients with liver cirrhosis 50-60% of UGI bleeding is due to

A

perforation or rupture of esophageal varices

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5
Q

in the event of a ruptured esophageal varices, what needs to be managed?

A

stop blood loss
maintain plasma volume
correct disorders in coagulation induced by cirrhosis
appropriate use of abx (infection by gram-negative organisms is commonly a concomitant)
blood volume resuscitation

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6
Q

blood volume resuscitation can lead to

A

increase in portal pressure—> more bleeding

worsen ascites

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7
Q

UGI bleed due to peptic ulcer disease often present with

A

hematemesis
coffee ground vomiting
melena
hematochezia

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8
Q

other complications due to UGE bleed from PUD

A 
anemia
fatigue
chest pain
syncope
SOB
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9
Q

isolated melena may originate anywhere from the ______ to the ______

A

esophagus

proximal colon

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10
Q

what increases risk for peptic ulcers

A 
h. pyloric infxn
ASA and NSAIDs
SSRIs
corticosteroids
anticoagulants
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11
Q

labs to evaluate UGI bleed

A

CBC
coagulation time
electrolytes

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12
Q

what is used to dx upper GI bleed

A

emergency upper endoscopy

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13
Q

Glasgow-Baltchford score

A 
systolic B/P:
100-109---> 1
90-99------> 2
 3
hemoglobin (men):
12-13----> 1
10-12----> 3
 6
hemoglobin (women):
10-12----> 1
 2
blood urea:
6.5-8----> 2
8-10------> 3
10-25----> 4
>25-------> 6
other markers:
pulse >100----> 1
melena---------> 1
syncope-------> 2
hepatic dz----> 2
cardiac fx-----> 2
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14
Q

Glasgow-Blatchford score is equal to 0 if all of the following are present:

A

hemoglobin level >12.9 (men) or >11.9 (women)
systolic BP >109
pulse >100
serum BUN

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15
Q

true or false: death in those pateitns with a GI bleed is more commonly due to other illnesses

A

true

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16
Q

define a lower GI bleed

A

occurs distal to the ligament of treitz (last 1/4 of the duodenum, entire jejunum, ileum, colon, rectum, anus)

17
Q

causes of lower GI bleed

A 
diverticulosis/diverticulitis
crohn's dz
UC
ischemic colitis
infectious colitis (esp. E. coli, shigella, salmonella, campylobacter)
angiodysplasia
neoplasm, polyps, cancer
hemorrhoids
18
Q

melena indicates blood that has been in the GI tract for at least ___ hours

A

8

19
Q

what is the sign of a significantly active GI bleed

A

hematochezia (bright red or maroon colored stool)

20
Q

maroon stools are associated with which side of the colon? bright red blood?

A

maroon from right side

bright red from left side

21
Q

diverticula are most commonly located where?

A

sigmoid
descending colon
(left side of colon)

22
Q

are left sided or right sided diverticula responsible for the majority of bleeding?

A

right sided (50-90%)

23
Q

colorectal adenocarcinoma is the ____ mc cancer in the US

A

3rd

24
Q

ischemic colitis frequently involes

A

the watershed areas—> splenic flexure and recto-sigmoid junction

25
Q

pathophys of ischemic colitis

A

ischemia causes mucosal and partial-thicknes colonic wall sloughing, edema, and bleeding

26
Q

pathophys of infectious colitis

A

either colonic tissue invasion by bacteria (salmonella or shigella) or toxin-mediated damage (e.coli)

27
Q

what are colonic angiodysplasias

A

arteriovenous malformations in the cecum and ascending colon; degenerative lesions that arise from chronic, intermittent, low-grade colonic contraction that obstructs the mucosal venous drainage

28
Q

what increases morbidity and mortality for lower GI bleeds?

A

poor renal fxn (creatinine >150)
age over 60 years
abnormal or low BP
persistent bleeding within the first 24 hours or presentation

29
Q

what diagnoses a lower GI bleed?

A

colonoscopy

30
Q

therapeutic intervention for diverticular bleed

A

colonoscopy with electric cauterization
epi injection
placemen tof metallic clips

31
Q

therapeutic intervention for recurrent bleed

A

resection of the affected bowel segment

32
Q

therapeutic intervention for angiodysplasia

A

electrocoagulation or laser coagulation

emergency medicine (4 decks)

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