GIS BLEEDING Flashcards
CHRONIC hemorrhages are hidden and occur with…….
anemia
in acute bleeding , it manifests as ………,………,and………..
hematemesis,melana,and hematochezia
bloody vomit
hematemesis
the color of the blood in the hematemesis depends on what?
-concentration of stomach acid
-contact time of the blood with the acid
-vomiting of fresh red blood
mostly when we can see fresh red blood in the hematemesis?
-when it is very new
-rapid
-large amount
-suggestive of bleeding from the area far from the acidic environment
Hb in the stomach ->oxidized ->by the effect of HCL -> vomiting like ………………..
coffee ground
HEMATEMESIS always indicates …………..GI bleeding .
-upper GI bleeding
(but in the sever bleeding of lower part we can see it too)
what is hemoptysis ?
when you cough up blood from your lungs
HEMATEMESIS often accompanied by MELENA.true or false
true
differentiation of HEMATEMESIS from………… is important
hemoptysis (cough of blood)
MELENA definition
-Black, tar-like, sticky and runny, foul-smelling
defecation.
-excretion of digested blood.
- At least 50 ml of bleeding and it must remain in the
digestive tract for 8 hours.
MELENA is a sign of ……………………….
-upper GI bleeding
(However, small bowel and proximal colon hemorrhages
◦ İf bowel passage is slow, it may cause a similar appearance.)
- In cases where the bleeding is too much and the
transit is too fast, a bleeding from the upper regions
may come out as red bleeding from the anus.
the color of stool may change depending on the what?
-location of the bleeding
-the intestinal transit rate
-the amount and speed of bleeding
less than half of those with MELENA also have ………………
hematemesis
HEMATEMESIS may not be present in GI bleeding in case of ……………….
pyloric stenosis
a 45 years old woman came in the emergency ,she complains of black stool and she afraid if it is MELENA ,but she has a history of using (charcoal, iron,bismuth) drugs ,and all of the other tests are normal ,what is your diagnosis ?
its the effect of Some drugs (charcoal, iron, bismuth) can stain stool
black
After the bleeding has stopped, black stool may
continue for……….days and gradually solidify and Stool occult blood may be positive for ………….days.
1-3 days,7-10 days
HEMATOCHEZIA definition
the presence of fresh red or dark red-cherry rot stool.
what is the difference between melena and hematochezia?
Melena is the passage of black, tarry stools. Hematochezia is the passage of fresh blood per anus, usually in or with stools.
HEMATOCHEZIA generally indicates ……………GI bleeding
-lower GI bleeding(distal to the leg of Treitz)
-(In case of severe upper GI bleeding and/or rapid
bowel passage, upper GI bleeding may also occur).
in HEMATOCHEZIA as the bleeding focus shifts distally , the color of the blood becomes …………….(darker/lighter)
lighter
what are the symptoms of patient with loss of less than 20% blood loss(<1000) in hematochezia
◦ Hardly any clinical signs.
◦ May be tachycardia after exertion.
what are the symptoms of patient with 20-25% (1000-1250 ml) blood loss in hematochezia
◦ HR> 100(tachycardia)
◦ Blood pressure is normal or slightly low when lying down.
◦ When sitting, there is a decrease in systolic BP of at least 10 mmHg and an increase in pulse rate of at least 20/min (Tilt test).
what are the symptoms of patient with 25-35%(1250-1800 ml) blood loss in hematochezia
Hypotension in the lying position.
◦ HR> 120
◦ Oliguria.
what are the symptoms of patient with more than 35%(>1800 ml) blood loss in hematochezia
◦ Deep hypotension
◦ HR> 140
◦ Shock is present.
if we have a pt with GI bleeding without tachycardia ,what could be the reason of no tachycardia?
maybe he or she has a history of using beta-blocker
in acute GI bleeding ,erythrocytes are…………
normocytic (not enough red cells)
in chronic GI bleeding ,erythrocytes are………………
microcytic(smaller than normal becuz of not enough hb
for upper GI bleeding we do ………….
early endoscopy (within 24hr)
If no pathology is found, colonoscopy is performed
after bowel cleaning (upper bleeding should also be
excluded in lower GI bleeding).
for lower GI bleeding we do…………….
rectosigmoidoscopy
(If no pathology is found, colonoscopy is performed
after bowel cleaning (upper bleeding should also be
excluded in lower GI bleeding).
when we use angiography in GI bleeding
indicates active bleeding over 0.5 ml/min
when we can take image in GI bleeding with scintigraphy?
for 36 hrs in bleeding above 0.5 ml/min
what are the clinic of upper GI bleeding
Hematemesis Melena Hematochezia (rare)!!! Bleeding signs Sometimes the first and only sign may be fainting on the
toilet. Angina, MI
what are the priorities treatment of upper GI bleeding?
-vascular access from both arms
-IV volume replacement
-antisecretory therapy (PPI)(only upper GIS bleeding)
-monitorization (BP,HR,Respiration rate)
-FM,History,diagnostic procedures
-nasogastric application-decompression
-endoscopic examination
PPI dosage in upper GIS bleeding
pantoprazol/esomeprazol 80 mg loading dose
-8 mg/hr infusion
who are the risky patients fo upper GIS bleeding
◦ Over 60 years old
◦ Whose first complaint is hematemesis
◦ With additional disease
◦ With hypotension, tachycardia and Tilt test (+)
◦ In shock
◦ Recurrent bleeding in the first 48 hours
◦ Those who describe hematochezia
◦ Variceal bleeding
◦ Requiring transfusion
◦ Those with evidence of active or new bleeding on endoscopy
◦ Those of the hard-to-find blood group
