GI bleeding Flashcards
occult GI bleeding suggestive symptoms
symptoms of anemia, iron deficiency or microcytosis, heme positive stools
what is occult GI bleeding defined as
positive fecal occult blood test with or without Fe deficiency anemia in absence of visible blood loss
what causes occult GI bleeding?
malignancy, peptic ulcers, vascular malformations, diverticula, inflammatory bowel dx
what is next step in evaluation of occult GI bleed if EGD and colonscopy are negative?
need a to look at small bowel with a wireless capsule endoscopy
adult meckel’s diverticulum
asymptomatic but can have painless GI bleeding in pts <2 yrs rare in pts >40 yrs.
when to order a radionuclide scan?
detects over GI bleeding and bleeding must be fairly rapid (0.1-0.5ml/min)
when to order a enteroclysis or double contrast study with injection barium and air into a tube that is passed through the small bowel
low diagnostic yield <20% and only performed if cannot do a capsule endoscopy
GI bleed algorithm
Transfusion goal is
Hgb>7
transfusion goal if they have possible variceal bleeding
Keep INR<3 for EGD and Plt >50 and can get FFP when appropriate
Severe anemia such as those with unstable coronary artery disease goal
Hgb >9 esp if they have unstable angina or ACS
Mallory Weiss tear is
upper GI mucosal tear with sudden increase in intraabdominal pressure from forceful retching
can cause subcuosal arterial or venule plexus bleeding.
Pts typically present with epigastric pain radiating to back and hematemesis after extended nausea and vomiting.
Mallory weiss tear
= bleeding is self limited to 24-48 hrs of bleeding.
How to evaluate and diagnose MW tear
EGD - done mostly to rule out other conditions like esophagitis from reflux, infection, pill induced
MW tears cause self limited bleeding. Usually located near distal esophagus and proximal stomach.
Treat with PPI but benefit is not clear.
threshold for safely doing urgent EGD based on INR
INR <1.5-2.5