GI bleeds Flashcards
What are the parts of the upper GI system?
Duodenum and up
What are lower GI bleeds?
Jejunum down
What does a positive guaiac indicate?
Usually slow bleeding, but does not help to localize
What does melena indicate?
Upper GI bleed
What does hematochezia indicate?
Colonic origin of the blood
Chronic GI blood loss will usually present concurrently with what? Acute?
Acute = hypotensive Chronic = Anemia
Large blood volume loss in a patient with preexisting CAD may indicate what?
Ischemic bowel
What is the qualification for diagnosing orthostatic hypotension?
20 mmHg fall upon standing
What happens to BS with GI bleeding?
Increased due to irritation
What is in the ddx for an upper GI bleed?
PUD
Erosive esophagitis
Gastroesophageal varices
Painful hematemesis = ?
Painless hematemesis = ?
Painful = mallory weiss tear
Painless = esophageal varices
What is a Dieulafoy’s lesion?
A medical condition characterized by a large tortuous arteriole in the stomach wall (submucosal) that erodes and bleeds. It can cause gastric hemorrhage but is relatively uncommon
What are the three ways to differentiate salmonella from shigella?
Salmonella has:
- Glucose fermentation
- H2S production
- Motile
What type of motility does listeria have?
Tumbling
What is the genetic cause of Peutz-Jeghers disease? ssx?
STK11 mutation
maculas over the oral mucosa, and predisposition to a variety of CAs
What is Osler-Weber Rendu syndrome?
an autosomal dominant genetic disorder that leads to abnormal blood vessel formation in the skin, mucous membranes, and often in organs such as the lungs, liver, and brain.
Presents with telangiectasia on the oral mucosa
If the BUN/creatinine ratio is greater than what value, what is this indicative of? Why is this?
> 30 then think upper GI bleed
Reabsorption of Hb proteins causes nitrogen metabolism
When is an NG tube indicated for an upper GI bleed? Why?
Severe hematochezia
BRB per NG tube is predictive, but not indicative of endoscopic lesion. (15-20% of patients with an upper GI bleed will not have blood on NG tube sample)
What type of IV do you want for resuscitating pts with acute GI bleeds?
Large bore peripheral IV access
When should resuscitation measures be undertaken with acute GI bleeds?
Tissue hypoxia
Hb