GI Bleeding

Question 1

what is considered upper GI Bleed?

Answer 1

proxial to ligament of treitz

Question 2

what is lower GI Bleed?

Answer 2

distal to ligament of treitz

Question 3

how often does this occur?

Answer 3

100/100000 ppl

Question 4

chronic GI Bleed presentation?

Answer 4

hemoccult + stools, iron deficiency anemia or both

Question 5

acute upper GI bleed presentation

Answer 5

hematemesis, melena or hematochezia

Question 6

most common cause of acute upper GI bleed?

Answer 6

peptic ulcers, esophageal varicies

Question 7

espohageal varices

Answer 7

dilation of the veins of the esophagous, usally at the distal end

Question 8

PP of esophageal varicies

Answer 8

underlying cause is portal hypertension (most commonly caused by cirrhosis- can be made worse by nsaids)

Question 9

budd-chiari syndrome

Answer 9

thrombotic or non-thrombotic obstruction of the portal vein- leaading to esophageal varices

Question 10

tx for esophageal varicies

Answer 10

hemodynamic support (fluid replacements, vasopressors)

**make sure you gve ABX too

Question 11

vassopressors moa/adr

Answer 11

vasopressin, somatostatin, octreotide

work by inbiting hormones- growth hormone, glucagon, insuin, LH VIP–> vasoconstriction

ADR: D, N, abdominal cramps, pooting, fat malabsorption

Question 12

what else can octreotide be used for?

Answer 12

acromegaly

Question 13

mallory-weiss tears

Answer 13

linear mucosal tear in the esophagus, generally at the gastroesophageal junction

often associated with alcohol use, but should be considered in all upper GI bleeds

Question 14

tx mallory-weiss tears

Answer 14

can be self-limiting, +/- injx of epinephrine or thermal coagulation

Question 15

acute lower BI bleed common causese

Answer 15

Diverticular dz, vascular malformation

Less common: IBd, hemorroids, non-malignant tumor

Question 16

acute lower GI bleed CF

Answer 16

hemoatochezia, bloody diarrhea, BRBPR

Question 17

hemorrhoids

Answer 17

varices of the hemorrhoidal plexus

external- visible perianally, usually painful

Question 18

stages of hemorrhoids

Answer 18

1-4

Question 19

stage 1 hemorrhoid

Answer 19

confined to the anal canal, may bleed with defecation

Question 20

stage II Hem.

Answer 20

protrude from the anal opening, but reduced spontaneously

+/- bleeding and mucoid discharge

Question 21

stage 3Hem

Answer 21

may require manual reduction after bM

Question 22

stage 4 hem

Answer 22

chronically proturding and risk strangulation

Question 23

tx for stage 1 and 2

Answer 23

high figer diet, increased fluids, bulk laxatives

Question 24

tx for 3

Answer 24

suppostitores with anestheitic and astringent properties

Question 25

refractory or stage 4

Answer 25

surgical tx, injx, rubber band ligation or sclerotherapy

Question 26

small bowel obstruction most common cause

Answer 26

adhesions or hernias (can also have neoplasm, IBD< volvulus-sigmoid or cecal area)

Question 27

large bowel obstructions

Answer 27

neoplasm (also, strictures, hernias, volvulus, intussusception, fecal impaction)

Question 28

SBO CF

Answer 28

abdominal pain, distenion, V of partial digested food, obstipation

Question 29

what is obstipation

Answer 29

severe or complete constipation

Question 30

bowel sounds in SBO

Answer 30

high pitched and comes in rushes- later, the bowel becomes silent

Question 31

LBO CF

Answer 31

distention and pain +/- fever, tachycardic, shock may insue

Question 32

lab finding with SBO and LBO

Answer 32

dehydration and electrolyte imbalance; upright radiographys may illustrate air-fluid levels

Question 33

tx of SBO/LBO

Answer 33

NPO, nasogastric suctioning, IV fluids, monitor