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Medicine II > GIB > Flashcards

GIB Flashcards

1
Q

prevalence

A

Males: Females = 2:1

more alcoholic men

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2
Q

UGI bleeding

A

30yo alcoholics –> varices

duodenal ulcers–> old rich people

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3
Q

Tear in the esophagus after you vomit is known as

A

Mallory-Weiss

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4
Q

mortality of GI bleeds

A

3-14%

8%

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5
Q

acute GI bleed continouse %

A

4/5 are fine

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6
Q

What labs

A

CBC-
INR
CMP

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7
Q

CBC, why do we get it and what are we looking at

A

a. Hemoglobin –> concentration per volume; even if you lose half your blood volume, your hemoglobin will be the same

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8
Q

why can you see normal hemoglobin

A

—> concentration per volume; even if you lose half your blood volume, your hemoglobin will be the same

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9
Q

the ratio of the volume of red blood cells to the total volume of blood.

A

Hematocrit

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10
Q

why do you see changes with chronic bleeding

A

c. If you have been chronically bleeding you will hold onto WATER (not blood or cells)

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11
Q

who dies from a GI bleed

A
  1. Shock, red blood; low BP
  2. Cause of bleeding (varices or cancer very bad)
    a. The cause does effect your risk
    i. Cirrhotic –> poor prognosis
  3. Comorbid disease
  4. Older age
  5. Onset in hospital
  6. Recurrent bleeding
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12
Q

why do you see varicies in alcoholics

A

Increase in portal vein you get esophageal and stomach varices

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13
Q

how does an NG tube work

A

o Withdrawal of blood is diagnostic for UGIB

oInsight as to acuity/ severity of bleed (coffee grounds, BRB, negative)

oAllows for clearance of stomach which can:
- Reduce risk of aspiration
- Clears the view for EGD
o”Easy” to place with little risk of complication

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14
Q

cons of a NG tube

A

o Uncomfortable
o Potential false negative if post-pyloric source
o Risk for sinusitis or bronchus placement

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15
Q

black stool usually indicative of

A

melena (bleeding is higher up; upper GIB –> blood gets acted on by bacteria in your colon which changes its color)

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16
Q

why would you see dark stool with a lower gib

A

Cecum is the top of the colon and cancer here could cause bleeding that takes a while and is seen and black

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17
Q

why would you see a red bleed with UGIB

A

has to be a HUGE volume of blood if its UGIB

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18
Q

White stool

A

very very rare acholic stool (bile obstruction from pancreatic cancer)

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19
Q

how much blood do you need for black stool

A

Only 50-100cc blood needed

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20
Q

why is stool black

A

oxidation from bacteria

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21
Q

Bright red blood per rectum AND blood in stomach

A

Bright red blood per rectum AND blood in stomach = that is a BAD UGIB

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22
Q

If clear stomach and black stool

A

you will do reasonably well; were previously bleeding

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23
Q

coffee grounds

A

oxidized blood

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24
Q

If I drop an NG tube in your stomach, and there is bright red blood

A
  • that means you are actively bleeding = that is VERY BAD
25
Q

a. Most common cause of UGIB

A

: PUD

26
Q

4 major risk factors for GIB

A

major Risk Factors

i. NSAIDs/ Aspirin
ii. Helicobacter pylori infection
iii. Physiologic Stress (i.e. hospitalized patients with life threatening illness)
iv. Gastric Acid

27
Q

Bleeding vessel is associated with what mortality

A

Bleeding vessel is associated with >10% mortality

28
Q

most common PU that bleeds?

A

b. Gastric > Duodenal

29
Q

most common stigmata with PUD

A

clean base

30
Q

stigmats seen with peptic ulcers

A 
clean base
flat spot
adherent
NBVV
Active bleed
31
Q

NBVV stands for

A

i. NBVV –> nonbleeding visible vessel

32
Q

chance of rebleeding with NBVV

A

Pts w/ NBVV has a 43% rebleeding risk

33
Q

chance of bleeding again with active bleed

A

55

34
Q

chance of rebleed with therapeutic endoscopy

A

20%

35
Q

what are the benefits to endoscopic therapy

A

20-40% early discharge
with loq risk
money saving

decreases rebleed by 50%

36
Q

effect of pH on platelet aggregation

A

a. Reduced pH is associated with reduced platelet aggregation
b. Clotting is pH dependent
i. Blood doesn’t like to clot at a pH of 1
1. Pepsin doesn’t work
2. Platelets don’t aggregate

37
Q

acid and it’s relationship to ulceration

A

acid causes ulcers

38
Q

how to control acid and minimize bleeding

A

PPIs reduce rebleeding and need for surgery, but do not effect mortality compared to control

h pylori eradication
stop NSAIDS

39
Q

how to minimize bleeding for low risk pt

A

stop taking NSAIDS and eradicate H pylori

40
Q

how to minimize bleeding risk in a pt that is high risk

A

endoscopic tx

PPI: prevention of stress related bleeding

stop NSAIDS and eradicate H pylori

maybe surgery

41
Q

what is a low risk bleeding pt look like (endoscopy assessment)

A

clean base or flat spot

or adherent clot

42
Q

what does a high risk pt look like (endoscopy assessment)

A

active bleed or visible vessel

43
Q

what does initial assessment look like for a pt with a bleed (not endoscopy)

A 
age greater than 60
comorbidity
low bp
red blood
shock 
ongoing bleed
prolonged cirrhosis
erratic mental status
44
Q

how many alcoholic cirrhosis or viral hepatitis pts get varices

what is the mortality rate for these pts

A

1/4 of pts with

and mortality in 30%

pressures are higher in the hepatic vein and back up

45
Q

tx for varices

A

banding

and octreotide adjunct for suspected varices

46
Q

octreotide

A

analog of somatostatin (in your body)
synthesized protein that lowers portal pressure and lower bleeding

it’s an adjunct to scoping and banding

47
Q

why are lower GI bleeds so difficult to find

A

very hard to stop diverticula bleeding because the cause is rarely identified
to stream like an ulcer

48
Q

AVM

A

arterial venous malformation

talangectasia

can be congenital
can be caused by radiation

49
Q

tx for lower GI bleed

A

no pharmocological tx
surgery
angiography (contrast) stop blood vessle through embolism
but usually resolves on its own

50
Q

occult bleeding tests

A

FOBT

used to do GAUIAC but that can detect blood in digested food
but now we do the FIT test (only measures human hemoglobin)

51
Q

if you have a positive blood occult test what next

A

colonoscopy

but most are just indicative of hemorrhoids

52
Q

how could we assess bleeding in the small bowel

A

might want to use a capsule
WCE

small bowel bleeding or crohns

53
Q

initial management

A

i. 2 large bore IVs
ii. Bolus NS
iii. Type and Cross blood
iv. Labs

54
Q

difference between hematocrit and hemoglobin

A

i.
Hematocrit is calculated from hemoglobin

This is a % of your blood that is blood cells

55
Q

% of pt with rebleeding in order from highest occurance and mortality to lowest

A 
varices
gastric cancer
peptic ulcers
gastric erosions
mallory weiss
56
Q

what % of melena is from UGI

A

70-90% melena is from an UGI source

57
Q

MCC of LGIB

A 
diverticulitis 
then malignancy
ischemic colitis
IBD
hemorrhoids
post polypectomy
58
Q

how many pts are controlled with LGIB treatment

A

no pharmological

therapeutic endocscopy only treats 20-30%

59
Q

Tx for pt at high risk for UGIB

A

heal ulcer with PPI

h pylori eradication
stop NSAID

Medicine II (21 decks)

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