GI Bleeding Flashcards
Who gets GI bleeds more often? Men or women
Men>Women
Most common cause of UGIB? Which location is more common?
PUD.
Gastric>Duodenal
Two types of UGIB associated with vomiting
Boerhaave and mallory weiss syndrome.
What is Boerhaave syndrome?
Spontaneous transmural rupture of the esophagul after forceful emesis. Scary shit, this kills you. MW is so not a big deal in comparison
What is the dividing line between UGIB and LGIB
Ligament of treitz
Most common cause of LGIB
Diverticular bleed
Which kind of GIB is more likely to stop spontaneously?
LGIB. 80-85% of the time
Typical primary WU of a GIB
Hx, PE, Labs
+/- NGT, this can piss off varices
Diagnostic studies (we’ll get into this)
Hx associated with a UGIB
Hemesis. BRB or coffee ground. Melena
PMH: of etoh, pregnancy, pud, GERD, liver cirrhosis, h pylori
Comorbid: CAD, CHF, RF, coagulopathy
Rx: NSAID, PPI, anticoag
Clinical manifestation of UGIB
Depends on the cause.
PUD? Epigastric/RUQ pain
Esophageal ulcer: GERD, dyaphagia
MW: Emesis, retching, coughing prior to hematemesis
Variceal: Jaundice, weakness, fatigue, ascites
Malignancy: dysphagia, involuntary weight loss, cachexia
Sx assoc with severe bleeding in UGIB
Hypovolemia sx. Orthostatic dizziness, confusion, angina, palps
Determining cause of LGIB by hx
Look at the symptoms prior to the bleeding!
LGIB- painless hx. Likely cause?
Diverticular bleed
LGIB- change in bowel habits hx. Likely cause?
Malignancy
LGIB- hx of abdominal pain & diarrhea. Likely cause?
Colitis
Clinical manifestation of LGIB
Painless bleeding most common! (Since diverticular is most common)
May sense fullness and need to pass stool
Hematochezia (BRBPR)
Melena is rare, more associated with UGIB. May occur if R sided bleed
GIB Labs to get
CBCw/diff
CMP (BUN/Cr)
COAG
ECG (for demand ischemia in elderly & hxCAD)
Why do we want a CMP in a GIB
BUN/Cr >20:1 suggests prerenal ischemia.
Diagnostic studies for GIB (and GS for UGIB and LGIB)
UGIB GS- Endoscopy. Can diagnose and treat
LGIB- Colonoscopy technically. But hard to do acutely.
We also have CT angio sclerotherapy, tagged RBC nuclear scan for LGIB (since cscope can be hard to do)
Role of nasogastric lavage in GIB
Controversal. Can tell us whether the bleeding is active or not for an UGIB, but if the patient has varices it can end poorly
Rx to give in acute UGIB
IV PPI (-prazole) IV Octreotide (transient reduction of Portal HTN)
Reversal agents (platelets, desmopressin)
UGIB management once hemodynamically stable
Endoscopy, treat it right then and there. Injection therapy, coag, band ligation.
Use of prokinetic agents prior to endoscopy for UGIB
Cause the contents of the stomach to empty faster, aids in visualization. Give 30-90 minutes before EGD.
Metoclopramide or erythromycin
UGIB pt failed endoscopy?
Angiography ww/ transarterial embolization. Last resort
