GI bleeding (hematemesis and rectal) pg 2216 Flashcards
What is hematemesis?
the vomiting of blood
what does “coffee ground” (black) color in your vomit suggest?
likely the origin of the bleed is at or distal to the stomach, since the blood had to interact with gastric acid.
what does bright red blood in your vomit suggest?
bleed is likely to be at or proximal to the lower esophageal sphincter
what is melena or dark black stool?
indicated upper GI bleed.
what is hematochezia?
bright red blood per rectum. indicative of lower GI bleed
likely causes of GI bleeding
peptic ulcer diseases 50%
mallory weiss 10%
erosive gastritis
melena develops after as little as how many ml of upper GI blood loss?
50 ml
what is the gold standard for definitive diagnosis of upper GI bleeds?
upper endoscopy.
why are labs of little value in the diagnosis of a GI bleed?
hematocrit takes 24-72 hrs to equilibrate
what are some labs to run for GI bleeds
CBC, PT/PTT, INR
what should be placed with all patient with suspected active upper GI bleed?
NG tube. can be diagnostic and therapeutic
management of a patient with upper GI bleed?
assess hemodynamic status:
SBP < 100 indicates severe blood loss, HR >100 moderate blood loss
IV volume replacement is necessary with FWB being the standard.
IV PPI are gold standard for severe bleeds.
clinical presentations of stool color is an indicator of underlying pathology. what does bright red blood suggest? in regards to lower GI bleeds.
colonic source.
clinical presentations of stool color is an indicator of underlying pathology. what does maroon stool indicate in regards to lower GI bleeds?
right colon or small intestine
clinical presentations of stool color is an indicator of underlying pathology. what does black tarry stools indicate in regards to lower GI bleeds?
a bleeding source proximal to the ligament of Treitz
