GI Bleeding Flashcards
what is considered upper GI Bleed?
proxial to ligament of treitz
what is lower GI Bleed?
distal to ligament of treitz
how often does this occur?
100/100000 ppl
chronic GI Bleed presentation?
hemoccult + stools, iron deficiency anemia or both
acute upper GI bleed presentation
hematemesis, melena or hematochezia
most common cause of acute upper GI bleed?
peptic ulcers, esophageal varicies
espohageal varices
dilation of the veins of the esophagous, usally at the distal end
PP of esophageal varicies
underlying cause is portal hypertension (most commonly caused by cirrhosis- can be made worse by nsaids)
budd-chiari syndrome
thrombotic or non-thrombotic obstruction of the portal vein- leaading to esophageal varices
tx for esophageal varicies
hemodynamic support (fluid replacements, vasopressors)
**make sure you gve ABX too
vassopressors moa/adr
vasopressin, somatostatin, octreotide
work by inbiting hormones- growth hormone, glucagon, insuin, LH VIP–> vasoconstriction
ADR: D, N, abdominal cramps, pooting, fat malabsorption
what else can octreotide be used for?
acromegaly
mallory-weiss tears
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
tx mallory-weiss tears
can be self-limiting, +/- injx of epinephrine or thermal coagulation
acute lower BI bleed common causese
Diverticular dz, vascular malformation
Less common: IBd, hemorroids, non-malignant tumor
acute lower GI bleed CF
hemoatochezia, bloody diarrhea, BRBPR
hemorrhoids
varices of the hemorrhoidal plexus
external- visible perianally, usually painful
stages of hemorrhoids
1-4
stage 1 hemorrhoid
confined to the anal canal, may bleed with defecation
stage II Hem.
protrude from the anal opening, but reduced spontaneously
+/- bleeding and mucoid discharge
stage 3Hem
may require manual reduction after bM
stage 4 hem
chronically proturding and risk strangulation
tx for stage 1 and 2
high figer diet, increased fluids, bulk laxatives
tx for 3
suppostitores with anestheitic and astringent properties
refractory or stage 4
surgical tx, injx, rubber band ligation or sclerotherapy
small bowel obstruction most common cause
adhesions or hernias (can also have neoplasm, IBD< volvulus-sigmoid or cecal area)
large bowel obstructions
neoplasm (also, strictures, hernias, volvulus, intussusception, fecal impaction)
SBO CF
abdominal pain, distenion, V of partial digested food, obstipation
what is obstipation
severe or complete constipation
bowel sounds in SBO
high pitched and comes in rushes- later, the bowel becomes silent
LBO CF
distention and pain +/- fever, tachycardic, shock may insue
lab finding with SBO and LBO
dehydration and electrolyte imbalance; upright radiographys may illustrate air-fluid levels
tx of SBO/LBO
NPO, nasogastric suctioning, IV fluids, monitor
