GI Bleeding Flashcards
What is the defining boundary of upper or lower GI bleeding?
Ligament of Trietz
What is the most common cause of upper GI bleed? And what two things cause it?
Peptic ulcer disease
Most common causes: H. pylori and NSAIDS
What are other causes of upper GI bleeding?
Esophageal varices Mallory-Weiss tears (nontransmural) Esophageal rupture Boerhaave's syndrome (transmural perforation) Gastric varices Angiodysplasia Cancer
What is angiodysplasia?
An artery and vein come together without the architecture of a capillary to buffer the pressure differences.
What is the first priority in dealing with esophageal varices?
Stopping blood loss and restoring volume
What is the mainstay of urgent treatment of esophageal varices rupture?
Therapeutic endoscopy
What is the difference between mallory-weiss and boerhaave’s?
Boerhaave’s is full thickness rupture and is much more serious.
What should you suspect in a pt presenting with hematemesis, coffee ground vomiting, melena, or hematochezia? Maybe anemia, fatigue, chest pain, syncope, SOB?
Upper GI bleed due to peptic ulcer disease
What medications increase the risk of peptic ulcers?
ASA and NSAIDS (x4)
SSRIs, corticosteroids, and anticoagulants
What is the the diagnostic and treatment option of first choice in the emergency evaluation of upper GI bleed?
Upper endoscopy
What criteria does the Glasgow-Blatchford score use?
Hemoglobin Systolic BP Pulse Serum BUN Melana or syncope Past or present liver disease or CHF
What does melenic stool most likely indicate?
4x more likely to come from an upper GI bleed. Black tarry stool that has been in the GI tract for at least 8 hours.
What does hematochezia indicate and how is it different from melena?
Bright red or maroon colored stool is a sign of active GI bleed. 6x more likely to come from a lower GI bleed.
Where do most lower GI bleeds originate?
Colon - 85%
Upper GI - 10%
SI - 3-5%
Where do diverticula most commonly occur and where are they most problematic?
75% occur on the left side of the colon, but 50-90% of lower GI bleeding from diverticulosis comes from the right side of the colon.
