GI BLEEDS Flashcards
NSAIDS and Stress (physiological) can cause what type of bleed?
Gastric/duodenal
Cirrhosis can cause what type of bleed(s)?
Esophageal varices & Portal Hypertensive gastropathy
Candida and ETOH can cause what type of bleed?
Severe/erosive esophagitis, gastritis, and duodenitis
Repetitive retching can cause what type of bleed?
Mallory-weiss tear
If you see severe belly pain with involuntary guarding or rebound tenderness – what should you consider?
Perforation
What is hematemesis?
Frank blood (vigorous active bleeding)
Coffee ground (slower more limited bleeding)
What is melena?
Black tarry stool (seen in various bleeds and can show up with less than 50cc of blood)
What is hematochezia?
bright red to maroon
Usually seen in lower GI bleed
What if hematochezia + hypotension indicate?
A MASSIVE UPPER BLEED!!
What is the progression of a patient going down the tubes with a GI bleed?
Stable vitals → Tachycardia with normal BP → Orthostatic hypotension (indicates 15% total volume loss) → Supine Hypotension (indicates 40% total volume loss)
About how much blood in the human body?
5L
What is the maximum survivable blood loss?
About 40%
AKA when they have supine hypotension – be VERY concerned
What testing should everyone get with a GI bleed?
CBC (H&H and Platelets)
CMP (BUN and Liver enzymes)
Coag panel (anticoag)
Type and Cross (for anticipated transfusion
What would the liver enzymes tell you?
Underlying liver problem
What would a BUN tell you?
Often associated with an upper bleed
If greater than 20:1
How often should we repeat an H&H?
Every 4-6 hours
If patient reports a little bit of witness GI blood loss, but normal vitals, and slight tachycardia – what do you do?
GI consult, IV PPI, Maybe transfusion, Upper endoscopy
What meds do we use for PPI treatment?
Olmeprazole = outpatient Protonics = inpatient
If a patient has frank red blood seen by his wife and again by the nurses – what do we do?
Get vitals!!/Cardiac monitor/Frequent BP checks
Establish 2 large bore IV sites
Give O2
Bolus IVF (Normal saline)
Prep for transfusion
IV PPI, octreotide (variceal bleed), reversal agents if anticoagulated
CALL!!! Urgent endoscopy, general surgery, and intensivist
What does an H&H tell you?
Is my patient still bleeding? Is the patient going down the tubes?
A drop in H&H by ___ is considered significant
1 gram drop
*Always remember hemodilution
An upper endoscopy is the same as what?
EGD
What do we need for a variceal bleed?
Octreotide, Endoscopy, TIPS procedure (transjugular intrahepatic portosystemic shunt, after 3 episodes)
If a patient has a GI bleed and they’re on an anticoagulation (Coumadin) – what do we do?
STOP Coumadin
Rank severity
Call the Pharm D
Reverse!! → Vit K IV or Kcentra + Vit K
What if your patient with a GI bleed is on a novel anticoagulant?
Call the pharm D → we don’t really know how to reverse it
What are some common causes of lower GI Bleeds?
Hemorrhoids, diverticulitis, colitis, or colo/rectal CA
How do we approach a lower GI bleed?
Rule-out an upper GI bleed THEN do a colonoscopy
How do we manage a lower GI bleed?
blood loss managed in the same way as an upper GI bleed
If a nurse calls you because a patient just pooped bright red blood and his BP 90/45 (which is much lower than before)?
Kick the system into HIGH GEAR! (the same system we talked about before)
What if your patient with BRB in his poop with decreased BP, you realized he’s on Coumadin – what do you do?
Stop Coumadin → Call Pharm D → Give Vit K and Kcentra → notify all consultants
