Gi bleedings Flashcards
most common cause of lower GI bleed
diverticulosis
diagnostic modality of choice for upper Gi bleed
upper endoscopy
how do you manage an upper GI bleed
fluid resiscutation
endoscopy
endoscopic management via injection therapy, thermal coagulation, hemostatic clips, fibrin or glue sealant
meds–> acid suppression with PPI (pantoprazole), octerotide for reducing splanchnic blood flow in variceal bleeding, TXA antifibrinolytic, supportive transfusion
get biopsy of gastric ulcers to rule out malignancy
what can cause lower GI bleed
diverticulosis
jejunal bleed (ulcers, polyps, tumours)
ileal and ileocecal bleed (meckels diverticulum in kids, SBO, crohns)
colonic bleed (CRC, crohns, ischemic bowel, UC, diverticulosis, pancolitis, post anastomotic bleed)
sigmoid bleed (cancer, diverticulosis, polyps, IBD)
rectum and anus (hemorrhoids, fissures, rectal ca, anal varices)
how do you manage LGIB
colonoscopy to detect and stop bleeding (75% stop spontaneously) or angiography
stepwise escalating approach (endoscopy–> IR–> surgery)
surgery–> oversew the bleeding vessel, cauterization, ligation, resection, clipping
what is the landmark that distinguished the UGIB from LGIB
ligament of treitz/suspensory ligament of the duodenum
what are the vessels likely involved in UGIB/LGIB
arcades of the celiac axis and SMA and IMA
what must be ruled out in a patients wtih LGIB
brisk UGIB
what is a major cause of gastric ulcers
h pylori
is a flagellated gram - bacteria that causes gastritis/duodenitis
high utation rate, motility to high pH through mucus, ability to attach to gastric mucosa epithelium, virulence against cells, urease activity against the acid
assocaited inflammation, metaplasia, immune response leading to ulcers
complications of PUD
UGIB–> managed with resuscitation and transfusion, PPI, endoscopic therapy
perforation (severe, diffuse abdo pain–> IV PPI, resuscitation, surgery
penetration of the ulcer through the bowel wall with or without free perforation and leakage of contents
gastric outlet obstruction/stricture
gastric ulcer sx
pain worsened by food, 1-2 hours after meals
vomiting/hematemesis
heartburn and chest pain and early satiety
duodenal ulcer sx
pain relieved by food/meals
melena
pain may awaken patient at night
pain 2-5 hours after eating
high risk features for re bleeding on upper GI endoscopy
active bleeding
exposed vessel
clot
clean based ulcer
when do you call the surgeon or refer in UGIB
hemodynamic instability despite vigorous resuscitation (more than 3 units transfused)
recurrent hemorrhage after initial stabilization (up to two attempts at endoscopic hemostasis)
shock associated with recurrent hemorrhage
continued slow bleeding with a transufion requirement exceeding three units per day
diagnosis of h pylori
indirect tests–> saliva, blood serology
direct tests–> breath test, stool antigen, biopsy, histopathology, rapid urease test
