HYHO UGIB Flashcards
What landmark differentiates an upper GI bleed from a lower GI bleed?
Ligament of Treitz = the suspensory ligament of the duodenum
Patient presentation associated with UGIB
- Hematemesis = vomiting blood
- Coffee-ground emesis
- Melena = dark, tarry stools
- Anemia
- Hypovolemic shock: low circulating blood volume triggers baroreceptors –> inc HR, inc sympathetic stimulation, blood directed away from skin, skeletal ms. –> pt appears cold, clammy, vasoconstricted
What specific cause of an UGIB is suggested by the following symptoms:
upper abdominal pain
Peptic ulcer
What specific cause of an UGIB is suggested by the following symptoms:
Odynophagia, gastroesophageal reflux, dysphagia
Esophageal ulcer
What specific cause of an UGIB is suggested by the following symptoms:
emesis, retching, or coughing prior to hematemesis
Mallory-Weiss tear
What specific cause of an UGIB is suggested by the following symptoms:
jaundice, abdominal distention (ascites)
Variceal hemorrhage or portal hypertensive gastropathy
** bleeding from esophagogastric varcies is the single most life-threatening complication of portal HTN
What specific cause of an UGIB is suggested by the following symptoms:
dysphagia, early satiety, involuntary weight loss, cachexia
Malignancy
Common medications that cause peptic ulcer formation
- aspirin
- - other NSAIDs (ibuprofen, naproxen, sodium, etc.)
Common medications that promote bleeding
- antiplatelt agents (clopidogrel)
- - anticoagulants (warfarin)
Medications that can alter clinical presentation (make you mistakenly think there is a GI bleed)
- Bismuth (pepto-bismol)
- iron
both can turn stool black
Key physical signs to look for when suspecting UGIB and what these signs indicate
- Vital signs - may indicate hemodynamic compromise, signs of shock
- Confusion - may indicate lack of blood flow/oxygen to brain
- Peripheral vasoconstriction - look for cool extremities, may indicate cyanosis
- Signs of liver disease - look for jaundice, ascites, caput medusa
What labs should you order when suspecting a UGIB
- CBC w/differential
- Coagulation studies (PT/INR), liver enzymes (AST, ALT), albumin, BUN, and creatinine
- Guaiac testing of stool - evaluates for blood in stool
What might a CBC w/diff tell you
- low platelets = may hinder coagulation
- transfuse if hemaglobin is < 7g/dL (in low risk patient), or below 9 g/dL (in high risk patient = the elderly, those with heart disease)
Four main intervention steps to remember for managing UGIB
- Initial resuscitation – focus on circulating volume
- Airway & Circulation – Intubate early with back-up and lots of suction
- Consults – GI, Radiology and/or surgery early for definitive diagnosis and treatment
- Give antibiotics
What spinal levels correspond to the GI system in general, which correspond to the upper GI specifically?
General GI: T1 - L2
Upper GI specifically: T5 - T9
Parasympathetics for upper GI
Vagus n. (OA and AA joints)
Chapman points for stomach acidity
Left 5th ICS
Chapman pint for stomach peristalsis
Left 6th ICS
The following are components of which category in the 5 model approach:
- Volume resuscitation using crystalloids; evaluate for transfusion needs
- Consider rib raising once pt is stable
- Address C3 - C5 phrenic n. to diaphragm fascia to improve excursion and thus pressure gradients to thoracic cage and associated lymph movement
- Indirect MFR to thoracolumbar diaphragm
Respiratory-Circulatory
The following are components of which category in the 5 model approach:
- Endoscopy or surgery to address source of bleeding
- Treat with PPI to facilitate healing of intestinal lining
- Eliminate NSAIDs
- Address nutritional needs (alcoholics commonly have deficits of B12 or folate)
Metabolic Energy
The following are components of which category in the 5 model approach:
– Address somatic dysfunctions, OA/AA, throacic spine; in the case of upper GI bleed, T5 - T9 for upper intestine
Biomechanical
The following are components of which category in the 5 model approach:
– Identify and treat viscerosomatic findings, chapman reflex points, and celiac ganglion
Neurologic
The following are components of which category in the 5 model approach:
– Assess patient for excessive alochol use and counsel for cessation
Behavioral
