GI bleeding and jaundice Flashcards
hematemesis
vomiting red blood or coffee grounds material
melena
black, tarry foul smelling stool
hematochezia
passage of bright red or maroon blood from the rectum
occult blood
absence of overt bleeding but presence of iron deficiency or positive fecal blood test.
common symptoms of anemia
lightheadedness, syncope, angina, dyspnea.
common causes of upper GI bleed
ulcers, varices, gastroduodenal erosions, mallory-weiss tears, erosive esophagitis, neoplasm, vascular ectasia, no source.
what does hematemesis tell us
there is probably an upper GI source, above the ligament of treitz
what does melena tell us
blood present in the GI tract for at 12-14 hours and as long as 3-5 days
what does hematochezia tell us
usually from a lower GI source or from a brisk UGI source in patients that are hemodynamically unstable.
melena or hematochezia
small bowel source
what is the most common presentation of UGIB
hematemesis and melena, hematemesis, melena
what is the most common cause of UGIB
peptic ulcer.
what are the causes of peptic ulcers
NSAIDs and H pylori
mallory-weiss tears
vomiting, retching, coughing preceeding hematemesis, especially in alcoholic patient.
esophageal varices
suspect with cirrhosis, poorest outcome among all UGIB.
hemorrhagic and erosive gastropathy/gastritis
cause mucosal lesions and thus not major bleeds. they are associated with alcohol and NSAID use.
what is the medical therapy for peptic ulcer bleed
proton pump inhibitor, h pylori eradication, avoidance of NSAIDs,
risk of rebleeding for ulcer s
active, visible vessel, adherent clot, flat spot or pigmented, clean based ulcer,
how do we stop peptic ulcer bleeds
need platelet aggregation and fibrin formation which requires pH > 6.8 PPI will keep the pH in correct range. they are effective in peptic ulcer bleeding
what is the most effective treatment for bleeds
proton pump inhibitors and endoscopy treatment.
how do small intestinal bleeds present
melena or hematochezia
what are the most common causes of small intestinal bleeds
vascular ectasia, tumors, NSAID erosions or ulcers.
what is the most common cause of LGIB in children?
Meckels diverticulum.
what are the most common causes of LGIB
hemorrhoids and anal fissures. diverticula, vascular ectasia, neoplasm, colitis,
what are the most common causes of LGIB in children
inflammatory bowel disease and juvenile polyps.
characteristics of a diverticula bleed
abrupt onset, painless, massive LGIB, stops spontaneously in 80% of cases and rebleeds in 20-25%
jaundice
yellowish discoloration of tissue resulting from the deposition of bilirubin, sign of liver dysfunction or hemolytic disorder.
bilirubin metabolism
metabolite of heme, provides color to bile, stool, urine.
does unconjugated bilirubin enter the glomerular filtrate
no. it binds albumin with high affinity.
bilirubinemia
elevation of conjugated bilirubin fraction and thus liver disease.
