HYHO UGIB Flashcards
Why might anemia not be reflected in an initial CBC of acute blood loss?
Hemo-concentration of remaining circulating volume
When might signs of hypovolemic shock occur?
30-40% volume loss
Inadequate blood circulation detected baroreceptor reflex => increased HR and sympathetic stimulation with vasoconstriction of nonessential orans
Orthostatic hypotention may become evident at what volume depletion?
20-25%
Tachycardia may become present with what volume depletion?
15%
What is the single most life-threatening complication of portal HTN?
Bleeding from esophageal varices
Responsible for 1/3 of alld eaths in pts with cirrhosis
What medications may alter pt’s stool and cause sx of GI bleed?
ASA and other NSAIDs (ibuprofen, naproxen sodium)
Antiplatelet agents (clopidogrel) and anticoagulants (warfarin)
Bismuth, iron - can color stool black
When would you transfuse a pt with a GI bleed?
Hb <7 g/dL - low risk pts
Hb <9 g/dL - high risk pts
What labs might you want to get on a pt with a GI bleed?
CBC with differential
Coagulation studies
Guiac testing of stool
Initial resuscitation for UGIB
Evaluate hemodynamic stability
Obtain 2 large bore IV access (one for saline, one for blood products)
Consider central line placement
Crystalloid fluids if blood not available
Replace blood loss with blood products
Indications for a central line
Inadequate peripheral venous access
Infusion of materials that would be damaging to peripheral veins (chemotherapy)
Airway and circulation tx of UGIB
Consider intubation with prior supplemental O2
Fresh frozen plasma - INR >1.6
Keep platelets >50,000 if actively bleeding
Cross and match 2-4 units of blood PRBC
What is endoscopy with sclerotherapy?
IV injection of sclerosant to irriate lining of fein and causes vein to close or use thrombotic agent to incite clot formation to stop bleeding
Controls acute bleeding in 80-85% of pts
What is the TIPS procedure?
Transjugular intrahepatic portosystemic shunt - reduce portal systemic pressure shunting blood away from varices
Tract created b/w portal vein and hepatic vein with stent placement
Surgical intervention of GI bleed when endoscopic and TIPS is not indicated
Surgical resection and vessel ligation - high chance of rebleed
Splenorenal shunt - splenic vein reattached to L renal vein
What pharmacological agents may be used for peptic ulcer disease during initial endoscopy?
PPIs - omeprazole or esomeprazole 40 mg IV BID
What is the use for octreotide (somatostatin) in suspected seophagogastric varices and/or cirrhosis?
May help shunt blood away from varices
Reduces secretions and loss of blody fluid
What is the indication for use of fresh frozen plasma (FFP)?
Used to correct coagulation deficiency
Factor V and VII are available for up to 24 hours after thawing
Is whole blood used for transfusions?
NO, EXCEPT IN RARE AND DIRE SITUATION
Tx of choice for anemia
PRBC and crystalloid fluids
NOT WHOLE BLOOD
What is the indication for use of platelet transfusion?
Stop active bleeding or prevent spontaneous bleeding in cases of thrombocytopenia
Chapman’s point for stomach acidity
Left 5th ICS
Chapmans point for stomach peristalsis
L 6th ICS
GI viscerosomatic levels
T1-L2
(T5-9 specific to upper GI)
In a GI complaint, which model would “Assess pt for excessive alcohol use and counsel for cessation” fall under?
Behavioral
When should OMT be performed in a GI complaint?
After initial stabilization of pt and definitive tx of bleeding is identified
Rib raising, other gentle techniques
Presence of both hematemesis and melena suggests presence of what?
Brisk bleeding
What test would you use initially in a hemodynamically stable pt with hematemesis and/or melena?
Upper endoscopy
Colonoscopy if source not identified, small bowel evaluation if colonoscopy negative
If severe bleeding continues to occur after colonoscopy, what tests might you want to do?
CT angiography/push enteroscopy => deep small bowel enteroscopy => angiography, meckel’s scan, laparoscopy/laparotomy
