GI bleeds Flashcards
Define upper GI bleed
Bleeds originating prox to the Ligament of Treitz
MCC of upper GI bleed?
PUD
Aortoenteric fistula
Classically presents with a self-limited herald bleed herald bleed followed by massive hemorrhage
Usually 2/2 aortic graft
Diagnosis via CT angio
Stigmata of liver disease
Spider angiomata, palmar erythema, jaundice, and gynecomastia suggest liver disease
In upper GI bleed
If NG aspirate reveals bright red blood or blood clots –>
gentle gastric lavage
MC source of lower GI bleed
Upper GI bleed
Dyspepsia
Continuous or recurrent upper abdominal pain or discomfort
Radiation enteritis/colitis
abdominal cramping, tenesmus, urgency, bleeding, diarrhea, & incontinence.
Typically, these patients are managed symptomatically and supportively.
symptoms of most patients resolve within weeks of radiation therapy cessation
antispasmodics, analgesics, antidiarrheal agents combined with intravenous fluid replacement
Patient-related factors and the method of radiation therapy administration may intensify the effects of radiation-induced intestinal injury. Patient-related risk factors that are associated with an increased risk of radiation-induced enteropathy include the following:
Advanced patient age
Prior abdominal surgery leading to intraperitoneal adhesions (Adhesions fix portions of the small or large intestine in the radiated field.)
History of pelvic inflammatory disease
Hypertension
Diabetes mellitus
Thin physique
Administration of chemotherapy
Other risk factors (eg, collagen vascular diseases, xeroderma pigmentosum, Cockayne syndrome)
Analysis of multiple risk factors for predictive value demonstrated that multiple laparotomies, hypertension, and thin physique had the highest correlation with the development of radiation enteritis.
Acute radiation enterocolitis
Acute radiation enteritis occurs in almost all patients undergoing pelvic and abdominal radiation therapy. The degree of symptom severity varies, with approximately 15-20% of patients requiring an altered course of therapy. The most common symptoms include the following:
Cramping abdominal pain
Tenesmus
Nausea
Vomiting
Anorexia
Diarrhea
Hematochezia
Fever
The most common clinical finding is generalized abdominal tenderness without peritoneal signs. Rarely, severe acute enteritis is associated with massive hematochezia or bowel perforation.
Almost all patients who receive more than 150 rad per day develop acute radiation enteritis, either while undergoing therapy or shortly after completion of treatment. In 5-10% of patients, exposure of intestine to a total dose of greater than 5000 rad results in the development of severe chronic radiation enteritis.
BUN/Cr >40:1 is v suggestive of??
An upper GI bleed
Lead pipe sign
Ulcerative colitis
Coffee bean sign
Sigmoid Volvulus
Male = female in sigmoid volvulus
Male > female in cecal volvulus, more likely cecal in pregnancy
Phosphate in abdominal pain vs obstruction
?
40% general pop
60% elderly
Mortality in perforated appendicitis
Mekel’s diverticulum
Rule of twos
NM scan
