GI bleeds

Question 1

2 types of presentations of GI bleeds

Answer 1

1. overt

2. occult

Question 2

3 types of overt bleeds

Answer 2

1. hematemesis (red or coffee grounds
2. melena
3. hematochezia

Question 3

def. melena

Answer 3

• black maloderous stool caused by oxidation of blood in GI
• as little as 100mls
• can be caused by Fe tabs, pepto

Question 4

what defines upper and lower GI

Answer 4

ligament of treitz- duodeno-jujenal angle

Question 5

presentation of UG

Answer 5

melena or hematemesis

- chezia if bleed is brisk

Question 6

presentation of LG

Answer 6

hematochezia

- can be melena if small bowel or right colon

Question 7

4 common causes of UG

Answer 7

1. peptic ulcer disease
2. varices
3. esophagitis
4. mallory wiess

Question 8

natural Hx of UGB

Answer 8

if non-variceal 80% stop on their own

- MandM more driven by CV factors

Question 9

3 features that make you worried about massive bleed

Answer 9

1. hemo instability
2. hematochezia
3. high transfusion needs

Question 10

3 features that make you worried about outcome

Answer 10

1. > 60
2. concurrent illness
3. onset while hospitalized

Question 11

UGB mgmt

Answer 11

• not immed. endo
• ABCs
• PPI
• correct coag.
• then endo

Question 12

steps to resuscitation

Answer 12

1. protect airway
2. 2 large bore IVs
3. fluids
4. packed RBCs
   5 ICU

Question 13

aim of PPIs

Answer 13

correct acid

• higher pH causes clot stability
• in low pH platelets don’t function as well
• pepsin at low pH can destry clot

Question 14

when to give PPI

Answer 14

prior to endo - give bolus

Question 15

3 roles of endo

Answer 15

1. diagnosis bleed
2. risk strat (pronosis)
3. treat lesion

Question 16

types PUD from least risk to most (5)

Answer 16

1. clean base - low risk
2. flat spot - low
3. adhernet clot - intermediate
4. nonbleeding visible vessel - hihg
5. active bleed- high

Question 17

what to do with risk levels

Answer 17

low - no endo therapy

high do endo therapy

Question 18

3 types of endo treatments

Answer 18

1. thermal
2. mechanical (clips, band)
3. meds (injection sclerotherapy)

Question 19

2 options to control if endo doesn’t work

Answer 19

1. angiography with embolization

2. surgery

Question 20

main cause of varices

Answer 20

increase in the portal system due to liver disease causes splanchnic vasodilation

Question 21

required diff. for varcieal formation

Answer 21

12mmHg

Question 22

when to suspect varices

Answer 22

• liver disease/alc
• esopha» gastric
• cirrosis - predictiove of rebleeds

Question 23

treatment of eso variceal bleeds

Answer 23

1. resuc
2. medical
   - octereotide
   - PPI
   - prophylactic ABs
3. endo ligation
4. TIPPS shunt
5. if all else fails balloon tanponade

Question 24

what is octreotide

Answer 24

somatostatin analog

- reduces blood flow to splanchnic circ.

Question 25

what is different tretament option for gastric variceal bleeds

Answer 25

can use endo to glue

Question 26

2 main presentations of LGB

Answer 26

1. hematochezia

2. melena

Question 27

2 other important aspect to ask about with LGB

Answer 27

1. pain

2. constipation

Question 28

when to suspect hematochezia is from UGB

Answer 28

• 10-15%

- when there is hemodynamic instability

Question 29

what is MAIN cause of pain less LGB

Answer 29

divertiulosis
then
-hemor
- CA
meckels

Question 30

1 cause of painful LGB

Answer 30

anal fissures

Question 31

acute LBG mgmt

Answer 31

1. ABC
2. correct coagulopathy
3. colonscope
4. 80% stop without intervention

Question 32

aims of scope for LGB

Answer 32

1. can ID lesion

2. sometimes treat

Question 33

def. red cell scanning

Answer 33

put in radio red cells and look where they go

Question 34

what is obscure GI bleeds

Answer 34

source no IDed as UG or LG - 5%

- usually small bowel