GI bleeds Flashcards

1
Q

2 types of presentations of GI bleeds

A
  1. overt

2. occult

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2
Q

3 types of overt bleeds

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

def. melena

A
  • black maloderous stool caused by oxidation of blood in GI
  • as little as 100mls
  • can be caused by Fe tabs, pepto
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4
Q

what defines upper and lower GI

A

ligament of treitz- duodeno-jujenal angle

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5
Q

presentation of UG

A

melena or hematemesis

- chezia if bleed is brisk

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6
Q

presentation of LG

A

hematochezia

- can be melena if small bowel or right colon

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7
Q

4 common causes of UG

A
  1. peptic ulcer disease
  2. varices
  3. esophagitis
  4. mallory wiess
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8
Q

natural Hx of UGB

A

if non-variceal 80% stop on their own

- MandM more driven by CV factors

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9
Q

3 features that make you worried about massive bleed

A
  1. hemo instability
  2. hematochezia
  3. high transfusion needs
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10
Q

3 features that make you worried about outcome

A
  1. > 60
  2. concurrent illness
  3. onset while hospitalized
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11
Q

UGB mgmt

A
  • not immed. endo
  • ABCs
  • PPI
  • correct coag.
  • then endo
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12
Q

steps to resuscitation

A
  1. protect airway
  2. 2 large bore IVs
  3. fluids
  4. packed RBCs
    5 ICU
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13
Q

aim of PPIs

A

correct acid

  • higher pH causes clot stability
  • in low pH platelets don’t function as well
  • pepsin at low pH can destry clot
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14
Q

when to give PPI

A

prior to endo - give bolus

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15
Q

3 roles of endo

A
  1. diagnosis bleed
  2. risk strat (pronosis)
  3. treat lesion
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16
Q

types PUD from least risk to most (5)

A
  1. clean base - low risk
  2. flat spot - low
  3. adhernet clot - intermediate
  4. nonbleeding visible vessel - hihg
  5. active bleed- high
17
Q

what to do with risk levels

A

low - no endo therapy

high do endo therapy

18
Q

3 types of endo treatments

A
  1. thermal
  2. mechanical (clips, band)
  3. meds (injection sclerotherapy)
19
Q

2 options to control if endo doesn’t work

A
  1. angiography with embolization

2. surgery

20
Q

main cause of varices

A

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

21
Q

required diff. for varcieal formation

22
Q

when to suspect varices

A
  • liver disease/alc
  • esopha» gastric
  • cirrosis - predictiove of rebleeds
23
Q

treatment of eso variceal bleeds

A
  1. resuc
  2. medical
    - octereotide
    - PPI
    - prophylactic ABs
  3. endo ligation
  4. TIPPS shunt
  5. if all else fails balloon tanponade
24
Q

what is octreotide

A

somatostatin analog

- reduces blood flow to splanchnic circ.

25
what is different tretament option for gastric variceal bleeds
can use endo to glue
26
2 main presentations of LGB
1. hematochezia | 2. melena
27
2 other important aspect to ask about with LGB
1. pain | 2. constipation
28
when to suspect hematochezia is from UGB
- 10-15% | - when there is hemodynamic instability
29
what is MAIN cause of pain less LGB
``` divertiulosis then -hemor - CA meckels ```
30
1 cause of painful LGB
anal fissures
31
acute LBG mgmt
1. ABC 2. correct coagulopathy 3. colonscope 4. 80% stop without intervention
32
aims of scope for LGB
1. can ID lesion | 2. sometimes treat
33
def. red cell scanning
put in radio red cells and look where they go
34
what is obscure GI bleeds
source no IDed as UG or LG - 5% | - usually small bowel