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Emergency Medicine > GI Bleeding > Flashcards

GI Bleeding Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

GI bleeding definition

A

pertains to every form of hemorrhage in the GI tract from the pharynx to the rectum

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2
Q

Upper GI bleeding

A

hemorrhage from any source between the pharynx and ligament of Treitz

Considered medical emergencies

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3
Q

What is an upper source of GI bleeding usually characterized by?

A

Hematemesis and melena

Dx made more easily when pt has hematemesis

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4
Q

Esophageal varices

A

Potential source of upper GI bleeding

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5
Q

Emergent tx of esophageal varices

A

Care directed at sopping blood loss, maininting plasama volume, correcting disorders in coagulation induced by cirrhosis and appropriate use of abx (infxn by gram- organisms commonly concomitant or precipitant)

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6
Q

Therapeutic tx of esophageal varices

A 
Variceal ligation (banding)
Sclerotherapy
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7
Q

Potential causes of upper GI bleeding

A 
Bleeding esophageal varices
Mallory-Weiss tears
Esophageal rupture
Boerhaave's syndrome
Bleeding gastric varices
Angiodysplasia
Cancer
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8
Q

How do pts w/ upper GI bleeding due to peptic ulcer dz often present?

A

Hematemesis
Coffee ground vomiting
Melena
Hematochezia

May also present w/ complications of anemia such as fatigue, syncope and SOB

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9
Q

Boerhaave’s Syndrome

A

spontaneous perforation of the esophagus that most commonly results from a sudden increase in intra-esophageal pressure combined with negative intra-thoracic pressure such as in straining, coughing or vomiting

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10
Q

Caput Medusa

A

Appearance of distended and engorged peri-umbilical veins, which are seen radiating from the umbilicus across the abdomen to join systemic veins

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11
Q

Medications that increase the risk of upper GI bleeds

A

ASA and NSAIDs (4x increased risk)
SSRIs
Corticosteroids
Anticoagulants

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12
Q

Initial PE for upper GI bleed

A
  1. VS: determine severity of bleeding and timing of intervention
  2. CV and lung exam
  3. Abdominal and rectal exam –> to determine possible causes of hemorrhage
  4. Assess for portal hypertension and stigmata of chronic liver dz to see if bleeding is coming from a variceal source
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13
Q

Recommended labs for upper GI bleeds

A

CBC
Coagulation time
Electrolytes
Cross matching of blood for possible later transfusion

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14
Q

Diagnostic and tx option of first choice for upper GI bleeds

A

Emergency upper endoscopy

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15
Q

Glasgow-Blatchford bleeding score

A

Score equal to “0” is low. Requirements:

  1. Hgb level >12.9 g/dL (men) or >11.9 g/dL (women)
  2. Systolic BP >109 mmHg
  3. Pulse
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16
Q

Lower GI bleed definition

A

A bleed that occurs distal to the ligament of Treitz including the last 1/4 of the duodenum and entire area of jejunum, ileum, colon, rectum and anus

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17
Q

Potential causes of lower GI bleeds

A
  1. diverticulosis, diverticulitis
  2. Crohn’s
  3. UC
  4. Ischemic colitis
  5. Infectious colitis
  6. Angiodysplasia
  7. Neoplasm, polyps, cancer
  8. Hemorrhoids
18
Q

Melena

A

Black tarry appearing stools that usu indicate blood that has been in the GI tract for at least 8 hours

4x more likely to come from an upper GI bleed than lower GI

19
Q

Hematochezia

A

Bright red or maroon colored stool
Sign or a significantly active GI bleed

6x more likely to represent a lower GI bleed instead of an upper bleed

20
Q

Where are diverticula most commonly located?

A

Sigmoid and descending colon

21
Q

True diverticula

A

includes all layers of bowel wall

22
Q

False diverticula

A

Includes serosa and mucosal layer of bowel wall

23
Q

Right sided diverticula are responsible for what % of lower GI bleeding secondary to diverticulosis?

A

50-90%!

However, 75% of diverticula occur on the left side of the colon

24
Q

Colorectal carcinoma

A

Causes occult bleeding as a result of mucosal ulceration or erosion

25
Q

Third most common cancer in the US

A

Colorectal adenocarcinoma

26
Q

Ulcerative Colitis

A

Causes bloody diarrhea in most cases
In up to 50% of UC pts mild to moderate LGIB occurs
Approximately 4% have massive bleeding

27
Q

Crohn’s Dz

A

1-2% of pts with Crohn’s may experience massive bleeding

Frequency of bleeding more common w/ colonic involvement than with small bowel involvement alone

28
Q

Ischemic colitis

A

Dz of the elderly, commonly observed in the 6th decade of life
Ischemia causes mucosal and partial-thickness colonic wall sloughing, edema and bleeding

29
Q

Where does ischemic colitis often times occur?

A

Frequently involves splenic flexure and recto-sigmoid junction

30
Q

What is the most common form of ischemic injury to the digestive system?

A

Ischemic colitis

31
Q

Main clinical manifestations of ischemic colitis

A

Abdominal pain & bloody diarrhea

32
Q

Infectious colitis pathophysiology

A

May be due to colonic tissue invasion by bacteria such as salmonella or shigella or toxin-mediated damage as with E. coli 0157:H7

33
Q

Angiodysplasia

A

Arteriovenous malformations located in the cecum and ascending colon
Most = degenerative lesions that come from chronic, intermittent, low-grade colonic contraction that obstructs the mucosal venous drainage.

34
Q

Risk factors for increased morbidity and mortality with lower GI bleeds

A

Poor renal function
Age >60 years
Abnormally low BP
Persistent bleeding within first 24 hours of presentation

35
Q

Standard of care for dx of lower GI bleeds

A

colonoscopy

36
Q

When is angiography performed with a lower GI bleed?

A

In hemodynamically unstable patients and in those w/ brisk ongoing LGIB
OR
If colonoscopy has failed to identify a bleeding site

37
Q

3 components of the management of LGIB

A
  1. Resuscitation and initial assessment
  2. Localization of the bleeding site
  3. Therapeutic intervention to stop bleeding at the site
38
Q

Indications for surgery w/ LGIB

A

Persistent hemodynamic instability with active bleeding
Persistent, recurrent bleeding
Transfusion of more than 4 units packed RBCs in a 24-hour period w/ active or recurrent bleeding

39
Q

Therapeutic options for diverticular bleeding

A

Colonoscopy w/ electric cauterization, epi injection or placement of metallic clips

40
Q

Therapeutic options for recurrent bleeding

A

Resection of the affected bowel segment

41
Q

Therapeutic options for angiodysplasia

A

Electrocoagulation or laser coagulation

Emergency Medicine (8 decks)

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