GI Bleeds and Obstructions Flashcards
Definitions
Hematemesis
Melena
Hematochezia
IDA
Occult Bleeding
Hematemesis: blood in the vomit
- can be bright red blood = acute (especailly if clotted!)
- can be “coffee ground emesis” = old not active bleeding
Melena = dark tarry stool
- indicating there was an “old bleed” commonly think Upper GI because it took a while to pass
Hematochezia = bright red blood per rectum (BRBPR)
- think active bleed, lower GI bleed, recatl/anal bleeding
IDA = iron deficiency anemia
- symptoms of anemia or unexplained anemia can signal that there is chronic bleeding
Occult Bleeding = bleeding on DRE
- found through FOBT, meaning not gross bleeding, but postive for microscopic bleeding
Differentiating Bleeding on Presentation
- Inital Evaluation
- questions related to the bleeding
- painless v painful
Inital Evaluation
- ABCs; airway compromise is possible in an upper GI bleed
- sick or not sick? evaluted vitals, mental status
significant blood loss = hypotension, tachycardic, AMS due to lack of perfusion
Chaaracterize the Bleed
- vomiting or rectal; color, amount
- associated symptoms
- hisory and med use
- foods! that can change stool color
Color
- Melena = upper GI bleed
- Maroon = R colon or SI
- Brown mixed/streaked = think rectal/anal
- large volume blood = think colon
Painless
- lots of bleeding: diverticular bleeding
- mild bleeding: hemorrhoids
Painful
- ischemic colitis
- infectious coloitis
- IBD
Labs
- CBC: Hgb (if HGB < 7 = transfusion warrented & platlets less than 50)
- get PT/INR, fibrinogen
- BMP (electrolytes)
- EKG
- hepatic chemistires
Upper GI bleed
- location
- presentation
- labs & imaging
- causes
Upper GI Bleed
- defined as bleeding from the GI tract above the ligament of Treitz
Presentation
- melena of stool
- hematemisis
- hematochemiza if massive bleed
Labs & Imaging
- fevers, tacyhcardic, tachypneic and hypotensive possible
- leukocytosis, anemia, low platelets, elevated BUN/AKi, electrolyte dysfunction (metabolic alkalosis or hyperkalemia)
- endoscopy can diagnose and treat
Causes
- peptic ulcers most common cause of an upper GI bleed
- esophageal varices
- mallory-weiss or borrheaves
- angioectasias (stars) and telangiectasis (spides)
- dieulofoy lesions = large caliber submucoasla arteries
Upper GI Bleed
Diagnosis and Treatment
all pt. should be made NPO
- NG tube placement can be done to aspirate &/or decompress
Imagins
- upper endoscpy if pt. is STABLE
- CT if pt. is UNSTABLE
- can do a KUB upright xray to r/o performation
Treament
1. Endoscopy: find the course of the bleed
- determine the risk of re-bleeding
- high risk = active bleeding, visable vessel or adherent clot
- intervention vie endoscopt: epi, banding, endoclips, etc.
- Acid Inhibition
- IV PPIs then transition to oral - Octreoctide
- usef in portal HTN
- used to recude the splanchinc blood flow and pressures - Intrarterial embolization
- through IR; cna be done for those with refractory bleeding
(last liine is surgery after IR but increase mortaltiy risk)
Lower GI Bleed
- locations
- Symptoms and signs
- Causes
Lower GI Bleed
- defined as bleeding from the GI tract below the ligament of treitz
Signs and Presentation
- hematochezia most commonly
- maorjity are from the colon
- lower GI bleeds are generally less severe than an upper GI
Causese
- most commonly: diverticualr bleeding within the colon - acute painless bleeding in large volumes
- neoplasms
- telangechtasisas and angioectasis
- IBD
- Anorectal Diseases (hemorrhoids) - think streaking
Lower GI Bleed
- Diagnosis
- Treatment
Diagnosis
- determine stability of pt. for colonoscopy v sigmoidoscpy
Acute with HD INSTABILITY
- CT angiography + IR embolization if source found
- Upper GI endoscopy to r/o upper GI source can put NG tube to aspirate (probably intubate)
- surgical treatment
GI bleed with HD STABLE pt.
anoscopy and sigmoidoscopy
colonscopy
if needed: capsule camera to assess small intestines
