Gi-Hemmorage

Question 1

Bleeding proximal to Liagament of Treitz is considered

Answer 1

upper GI

Question 2

Bleeding distal to Liagament of Treitz is considered

Answer 2

lower GI

Question 3

Upper Gi consist of

Answer 3

esophagus
stomach
duodenum

Question 4

Lower GI is

Answer 4

Jejenum
Iileum
Colon
Rectum

Question 5

Peptic ulcer disease is when ——secretions autodigest lyers of _______ ultimatly causing _________to vessles and ______.

Answer 5

Peptic ulcer disease is when gastric secretions autodigest layers of the stomach ultimately causing damage to vessels and hemmorage

Question 6

PUD is caused by

Answer 6

H pylori ( Low SES)
NSAIDs

Question 7

Stress related erosive syndrome is known as:
stats:
Location:

Answer 7

SRED is aka stress ulcer or hemoragic gastritis
develop rapidly
can be in stomach or duodenum
2nd leading cause of a GI bleed **

Question 8

SRES caused by

Answer 8

increased gastric secretion and decreased mucous blood flow

Question 9

who would be high risk SRES? no flow

Answer 9

trauma, shock, burns, neuro

Question 10

What are esophageal varices?

caused by:

Answer 10

esophageal varices are when the vessels become engorged and dilated–they are then vulnerable to damage from gastric secretions they can then rupture and hemmorage

Question 11

Who is at reisk for esophageal varices

Answer 11

alcholics-due to high portal tension
cirrosis
hep c b
people w/ fatty liver

Question 12

Diverticula-Lower Gi is what?

caused by and leads to?

Answer 12

diverticula is a sack like herniation of the lining of the small intestine or colon.

caused by low fiber, high fat , and weakening of the lining–>leads to inflammation and perforation

we can control by DIET !!!!!

Question 13

What is hematemesis?

what does this conclude?

Answer 13

Hematemesis is indication of an upper Gi Bleed

bright red profuse bleeding that has little contact wth acid meaning it doesn’t stay in stomach long.

Question 14

what is coffe ground indicate?

Answer 14

coffee ground indicates upper GI-

–this blood has stayed longer in the stomach and become oxidized by gastric secretions and enzymes

Question 15

what can be concluded by melena?

Answer 15

this is an upper GI Bleed
–this is black tarry stools
digestion of blood from upper Gi bleed
may take several days to clear

Question 16

how would we know the pt has a lower GI bleed?

Answer 16

if we see Hematochezia-bright red or blood streaked stools

my cause diarrhea

Question 17

what can cause hematochezia?

Answer 17

colon cancer
hemmoroids
AVM- ad venous malformations o the colon-these can be serious
polyps
inflamation of diverticulum

Question 18

what is occult bleeding?

Answer 18

bleeding in the lower GI invisible to the naked eye because it is so slow.

Question 19

Lab Liver enzymes in upper or lower GI disease

Answer 19

these will be elevated.

Question 20

BUN in Gi distress

Answer 20

will be increased because of protein digestion?

There is albumin in blood(protein)

Question 21

Electrolytes in Gi distress?

Answer 21

watch Ca-if givn blood
blood has citrate which binds to Ca

K may be elevated if given blood (K is leaked out)

Question 22

endoscopy

Answer 22

diagnostic procedure
pt must be hemodynamically stable
area to be viewed must be clear of blood
there must be a consent and explanation to the pt first

Question 23

Tagged RBC or mesenteric angiogram

Answer 23

RBC is nuclear-done if endo fails

mesenteric angiogram-Mesenteric arteriography is an examination of the abdominal vessels by using an injection of a contrast medium to help visualize the structures. The test is performed after an endoscopy proves to be inconclusive and cannot locate the source of bleeding in the intestinal system, or other studies prove inadequate in evaluating abnormal growths. It may also be used to evaluate vessel damage after an abdominal trauma

Question 24

wireless capsule endoscopy

Answer 24

pill that can be swallowed and evaluate the small intetine

Question 25

control or stop bleeding PUD

Answer 25

endoscopic thermal therapy-cauterize blood vessel
endoscopic injection-inject epi to vasoconstrict
vagotomy-sever the vagus nerve
phlorplasty-increase gastric empting

Question 26

Control or stop bleeding in SRES

Answer 26

angiogram–>inject dye vasopressin
gastrectoy
oversew ulcers

Question 27

control or stop blleding esophageal varices

Answer 27

vasopressin if HF give with nitro
somatostatin -no cardioeffects
betas
ballon tamponade-compresses hemmoraging in stomach and esophagus

Question 28

esophagogastric balloon tamponade are not kept

Answer 28

in place mpre than 24 hours

icu because they are at rik for aspiration and occlucion

Question 29

gastric perfortion
defined
s and S

Answer 29

perforation of abdominal contents into abdomen

sudden sever upper abdominal pain, right shoulder pain
rebound tenderness, abdominal rigity and vomitting

fever, tachy despite fluid replacement

Question 30

How would we stabilize a gastric perforation?

Answer 30

cystalloids
02
central line
large bore NG-irrigate till clear
ROOM TEMP NS-cold can prolong the bleeding time
keep ph above 4
REMEMBER TO DOCUMENT INSTILLED AND ASPIRATED
urinary catheter

Question 31

DIAGNOSIS AND TREATMENT OF PUD

Answer 31

10-14 day multi treatment

cessation of smoking cofee milk

Question 32

what kind of antibiotic will be given to a patient with PUD caused by h-pylori

Answer 32

tetra and amoxicillin w flagyl
PPI
Bismuth salts=destry cell walls of hpylori

Question 33

Treat PUD NSAID or non hpylori

Answer 33

H2 receptor antagonist==pepside,zantac, tagment, PPI, prostagalndins=increase mucus production
carafate