GI bleeds Flashcards
2 types of presentations of GI bleeds
- overt
2. occult
3 types of overt bleeds
- hematemesis (red or coffee grounds
- melena
- hematochezia
def. melena
- black maloderous stool caused by oxidation of blood in GI
- as little as 100mls
- can be caused by Fe tabs, pepto
what defines upper and lower GI
ligament of treitz- duodeno-jujenal angle
presentation of UG
melena or hematemesis
- chezia if bleed is brisk
presentation of LG
hematochezia
- can be melena if small bowel or right colon
4 common causes of UG
- peptic ulcer disease
- varices
- esophagitis
- mallory wiess
natural Hx of UGB
if non-variceal 80% stop on their own
- MandM more driven by CV factors
3 features that make you worried about massive bleed
- hemo instability
- hematochezia
- high transfusion needs
3 features that make you worried about outcome
- > 60
- concurrent illness
- onset while hospitalized
UGB mgmt
- not immed. endo
- ABCs
- PPI
- correct coag.
- then endo
steps to resuscitation
- protect airway
- 2 large bore IVs
- fluids
- packed RBCs
5 ICU
aim of PPIs
correct acid
- higher pH causes clot stability
- in low pH platelets don’t function as well
- pepsin at low pH can destry clot
when to give PPI
prior to endo - give bolus
3 roles of endo
- diagnosis bleed
- risk strat (pronosis)
- treat lesion
types PUD from least risk to most (5)
- clean base - low risk
- flat spot - low
- adhernet clot - intermediate
- nonbleeding visible vessel - hihg
- active bleed- high
what to do with risk levels
low - no endo therapy
high do endo therapy
3 types of endo treatments
- thermal
- mechanical (clips, band)
- meds (injection sclerotherapy)
2 options to control if endo doesn’t work
- angiography with embolization
2. surgery
main cause of varices
increase in the portal system due to liver disease causes splanchnic vasodilation
required diff. for varcieal formation
12mmHg
when to suspect varices
- liver disease/alc
- esopha» gastric
- cirrosis - predictiove of rebleeds
treatment of eso variceal bleeds
- resuc
- medical
- octereotide
- PPI
- prophylactic ABs - endo ligation
- TIPPS shunt
- if all else fails balloon tanponade
what is octreotide
somatostatin analog
- reduces blood flow to splanchnic circ.
what is different tretament option for gastric variceal bleeds
can use endo to glue
2 main presentations of LGB
- hematochezia
2. melena
2 other important aspect to ask about with LGB
- pain
2. constipation
when to suspect hematochezia is from UGB
- 10-15%
- when there is hemodynamic instability
what is MAIN cause of pain less LGB
divertiulosis then -hemor - CA meckels
1 cause of painful LGB
anal fissures
acute LBG mgmt
- ABC
- correct coagulopathy
- colonscope
- 80% stop without intervention
aims of scope for LGB
- can ID lesion
2. sometimes treat
def. red cell scanning
put in radio red cells and look where they go
what is obscure GI bleeds
source no IDed as UG or LG - 5%
- usually small bowel
