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GASTROENTEROLOGY > GI BLEEDING > Flashcards

GI BLEEDING Flashcards

1
Q

Most common cause of UGIB

A

Peptic ulcers

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2
Q

3 high risk findings of ulcer on endoscopy

A
  • Active bleeding
  • Nonbleeding visible vessel
  • Adherent clot
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3
Q

High-dose, constant infusion of IV PPI sustain intragastric pH of:

A

> 6

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4
Q

Rebleeding percentage of peptic ulcers within the next year if no preventive strategies done

A

10-50%

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5
Q

3 main factors in ulcer pathogenesis:

A
  • Helicobacter pylori
  • NSAIDs
  • Acid
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6
Q

Eradication of H. pylori decrease PUD rebleeding to:

A

< 5%

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7
Q

If necessary, what NSAID would you give in patient with GIB?

A

COX-2 selective plus a PPI

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8
Q

For GIB patients with CVD who takes low-dose aspirin for secondary prevention, when will you resume aspirin?

A

Restart aspirin ASAP after their bleeding episode (1-7 days)

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9
Q

For GIB patients who take aspirin for primary prevention, when will you resume aspirin?

A

No need to resume

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10
Q

If GIB is unrelated to H. pylori or NSAIDS, until when should you give PPI to patients?

A

Should remain on PPI therapy indefinitely because of rebleeding rates of 42% at 7 years

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11
Q

Most common bleeding site of Mallory-Weiss tear

A

Gastric side of the GEJ

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12
Q

Mallory-Weiss tear stops spontaneous in how many percent of cases?

A

80-90%

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13
Q

Recurrence rate of Mallory-Weiss Tear

A

0-10%

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14
Q

Poorer outcomes than other sources of UGIB

A

Esophageal varices

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15
Q

4 treatment for Esophageal varices

A
  • Endoscopic ligation
  • IV vasoactive medications
  • Non-selective beta blockers
  • TIPS
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16
Q

2 indications of TIPS in patient with BEV:

A
  • For patients with persistent or recurrent bleeding despite endoscopic and medical therapy
  • 1st 1-2 days of hospitalization for acute BEV in patients with advanced liver disease (Child-Pugh class C with score 10-13)
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17
Q

Endoscopically visualized breaks that are confined to the mucosa

A

Erosive disease

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18
Q

Cause of erosive esophagitis

A

GERD

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19
Q

Most important cause of gastric and duodenal erosions

A

NSAID use

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20
Q

Watermelon stomach

A

Gastric antral vascular ectasia

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21
Q

Aberrant vessel in mucosa bleeds from a pinpoint mucosal defect

A

Dieulafoy’s lesion

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22
Q

Hereditary hemorrhagic telangiectasias

A

Osler-Weber-Rendu

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23
Q

Prolapse of proximal stomach into esophagus with retching

A

Prolapse gastropathy

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24
Q

Bleeding from the bile duct

A

Hemobilia

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25
Q

Bleeding from pancreatic duct

A

Hemosucus pancreaticus

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26
Q

Percentage of obscure GIB that originate in the small intestine

A

~75%

27
Q

3 most common causes of small-intestinal GIB in >40 years old:

A
  • Vascular ectasias
  • Neoplasm
  • NSAID-induced erosions and ulcers
28
Q

Most common cause of significant small intestinal GIB in children

A

Meckel diverticulum

29
Q

Most common cause of LGIB

A

Hemorrhoids

30
Q

Aside from hemorrhoids and anal fissures, what is the most common cause of LGIB?

A

Diverticulosis

31
Q

Usual location of diverticulosis

A

Right colon

32
Q

Bleeding stop spontaneously in how many percent of diverticulosis?

A

~80-90%

33
Q

Rebleeding rate in diverticulosis

A

~15-40%

34
Q

Without source of GIB identified on UGIE and colonoscopy

A

Obscure GIB

35
Q

Bleeding vascular ectasias and aortic stenosis

A

Heyde’s syndrome

36
Q

2 most common causes of significant colonic GIB in children and adolescents

A
  • Inflammatory bowel disease

* Juvenile polyps

37
Q

Measurement of these 2 is the best way to initially assess a patient with GIB

A

Heart rate and BP

38
Q

It may take up to how many hours for Hgb to fall in acute GIB

A

72 hrs

39
Q

Hemoglobin does not fall immediately in acute GIB. Why?

A

Proportionate reductions in plasma and red cell volumes

40
Q

Transfusion is recommended once Hgb is _____. And what do you call this strategy?

A
  • ≤ 7 g/dL

* Restrictive transfusion strategy

41
Q

In melena, blood has been present in the GIT for how many hours?

A

≥ 14 h or as long as 3-5 days

42
Q

Aside from melena, what are 2 other clues of UGIB in differentiating with LGIB?

A
  • Hyperactive bowel sounds

* Elevated BUN

43
Q

3 baseline characteristics predictive of rebleeding and death in UGIB:

A
  • Hemodynamic compromise
  • Increasing age
  • Comorbidities
44
Q

Promotility agent to improve visualization? Dose?

A

Erythromycin 250 mg IV ~ 30 min before endoscopy

45
Q

In what subset of UGIB patients will you give antibiotics? And what antibiotics?

A
  • Cirrhotic

* Quinolone or ceftraixone

46
Q

May improve control of bleeding in cirrhotics with UGIB in the 1st 12 h after presentation

A

IV vasoactive medications

47
Q

When should you perform upper endoscopy? In high-risk patients?

A
  • Within 24 hrs

* Within 12 hrs

48
Q

BUN scoring in Glasgow- Blatchford score

A
  • 18.2 to <22.4 = 2
  • 22.4 to <28.0 = 3
  • 28.0 to <70.0 = 4
  • ≥ 70 = 6
49
Q

Hemoglobin scoring in Glasgow- Blatchford score (men and women)

A
  • 12 to <13 (men) = 1
  • 10 to <12 (women) = 1
  • 10 to <12 (men = 3
  • <10 = 6
50
Q

SBP scoring in Glasgow- Blatchford score

A
  • 100-109 = 1
  • 90-99 = 2
  • <90 = 3
51
Q

Heart rate scoring in Glasgow- Blatchford score

A

≥ 100 = 1

52
Q

Scoring of other markers in Glasgow- Blatchford score

A
  • Melena = 1
  • Syncope = 2
  • Hepatic disease = 2
  • Cardiac failure = 2
53
Q

In patients with hematochezia + hemodynamic instability, what procedure should you do first?

A

UGIE to rule out UGIB

54
Q

Procedure of choice for LGIB, unless bleeding is too massive

A

Colonoscopy

55
Q

Procedure for massive LGIB

A

Angiography

56
Q

Procedure for LGIB in patients < 40 years old with minor bleeding

A

Sigmoidoscopy

57
Q

Initial test in patients with massive bleeding from the small intestine

A

Angiography

58
Q

Next step in patients with GIB with negative UGIE or colonoscopy

A
  • Second-look procedure – repeat upper and lower endoscopy

* May also do push enteroscopy

59
Q

Inspect the entire duodenum and proximal jejunum with a pediatric colonoscope

A

Push enteroscopy

60
Q

If second-look procedure in GIB patient is negative, what is the next step?

A

Video capsule endoscopy (may also do push enteroscopy)

61
Q

May be used initially instead of video capsule in patients with possible small bowel narrowing

A

CT enterography

62
Q

If capsule endoscopy is negative, what is the next step?

A

Observe or do further testing with deep enteroscopy

63
Q

Next step if you have a positive FOBT:

A

Do colonoscopy

GASTROENTEROLOGY (2 decks)

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