L19: GI Bleeding Flashcards
Def of Hematemsis
Def of Melena
Def of Hematochezia
Hematochezia infrequently occurs with massive β¦.. GI bleeding that is typically associated with hypotension.
Upper
Hematemesis and relena usually indicate β¦.. GI bleeding β¦β¦ to the suspensory ligament of the duodenum, also called the ligament of β¦..
Upper, proximal, Trietz
β¦β¦. is the most common cause of upper GI bleeding.
Peptic ulcer disease (PUD)
Hematochezia is most often associated with β¦.. Gl bleeding.
lower
Gastrointest nal bleeding indicates underlying pathology in either the upper or lower gastrointestinal (Gl) tract.
Diagnosis is nade by clinical history and physical exam, followed by upper and /or lower Gl endoscopy
The source of the bleeding can usually be identified and treated with endoscopy.
Incidence of UGIB
Risk Factors of UGIB
Incidence of LGIB
Risk Factors of LGIB
Most Common Causes of UGIB
The source of bleeding is not identified in up to β¦..
(10%- 15%) of patients.
Esophageal Causes of UGIB
Gastric Causes of UGIB
GAVE
Dieulofy Lesions
Angiodysplasia
Duedenal Causes of UGIB
Diverticular Causes of LGIB
Diverticulosis
Diverticulitis
Meckel Diverticulum
Angiodysplasia as a cause of LGIB
Ischemia
Internal Hemorrhoides
Anal Fissure
- Cause of LGIB
Neoplastic Causes of LGIB
Inflammatory Causes of LGIB
Iatrogenic Causes of LGIB
Aortoenteric Causes of LGIB
Asymptomatic GI Bleeding
Anemia in GI Bleeding
Pain & Heartburn in GI Bleeding
CP of GI Bleeding
- UGIB
CP of GI Bleeding
- Melena
CP of GI Bleeding
- Hematochezia
CP of GI Bleeding
- Weight Loss
Patients with mild or occult bleeding may β¦..
not have significant findings.
Genral Examination in GI Bleeding
The approach to evaluating patients with GI bleeding β¦β¦.. and whether the patient is able to undergo endoscopic evaluation.
depends on its severity
Rectal Examination in GI Bleeding
Liver Examination in GI Bleeding
Diagnosis and management are often approached concurrently.
β¦
Approach to Dx & TTT of GI Bleeding
Approach to Dx & TTT of GI Bleeding
- Initial Stabilization
Approach to Dx & TTT of GI Bleeding
- Initial Stabilization (Airway & Breathing)
Approach to Dx & TTT of GI Bleeding
- Initial Stabilization (Circulation)
Approach to Dx & TTT of GI Bleeding
- Initial Assessment
Approach to Dx & TTT of GI Bleeding
- Initial Assessment (CBC)
Approach to Dx & TTT of GI Bleeding
- Initial Assessment (Blood Type & Cross-Match)
Approach to Dx & TTT of GI Bleeding
- Initial Assessment (Coagulation Factors)
Approach to Dx & TTT of GI Bleeding
- Initial Assessment (FOBT)
Approach to Dx & TTT of GI Bleeding
- Initial Assessment (LFTs)
Approach to Dx & TTT of GI Bleeding
- Initial Assessment (Basic Metabolic Panel)
Approach to Dx & TTT of GI Bleeding
- Initial Assessment (Anemia Workup)
Indication for blood transfusion in GI Bleeding
Indication for blood transfusion in GI Bleeding
- Hemodynamically stable without cardiovascular disease
Indication for blood transfusion in GI Bleeding
- Hemodynamically stable with cardiovascular disease
Indication for blood transfusion in GI Bleeding
- Patients who require massive transfusion
Drugs to stop & Continue in GI Bleeding
Interventions for GI Bleeding after Resuscitation
Interventions for GI Bleeding after Resuscitation
- For Hemodynamically Unstable
Interventions for GI Bleeding after Resuscitation
- For Hemodynamically Stable
Interventions for GI Bleeding after Resuscitation
- For Hemodynamically Stable (Suspected UGIB)
Interventions for GI Bleeding after Resuscitation
- For Hemodynamically Stable (Suspected LGIB)
Most patients with β¦β¦. require hospitalization for management and to ensure the patient is stable.
UGIB
β¦β¦ may be managed as an outpatient in patients at low risk of adverse outcomes.
LGIB
About β¦.. of cases of GI bleeding will stop without intervention.
80%
Indications for admission & referral in GI Bleeding
Bleeding Scoring Systems in GI Bleeding
Glascow-Blatchford Bleeding Score
Use of Glascow-Blatchford Bleeding Score
Importance of Glascow-Blatchford Bleeding Score
Factors Considered in Glascow-Blatchford Bleeding Score
Assessment of Glascow-Blatchford Bleeding Score
Rockall Bleeding Score
Uses of Rockall Bleeding Score
When is Rockall Bleeding Score Applied?
Factors Considered in Rockall Bleeding Score
Assessment of Rockall Bleeding Score
Oakland Bleeding Score
Uses of Oakland Bleeding Score
Factors Considered in Oakland Bleeding Score
Assessment in Oakland Bleeding Score
DDx of GI Bleeding
Causes of Epistaxis
Diffrentiation of Epistaxis from GI Bleeding
Managment of Epistaxis
Some foods or medicines can cause false positive fecal occult testing like β¦β¦
β¦β¦. can cause black, tarry stools that are negative for fecal occult
Bismuth
Patients should avoid these foods and medications β¦β¦ before fecal occult blood testing.
48 hrs
Cause of Hemoptysis
Def of Hemoptysis
Dx of Hemoptysis
TTT of Hemoptysis
Managment of Massive GI Bleeding
managment of Moderate GI Bleeding
Managment of Mild GI Bleeding
What should you exclide first in managment of GI Bleeding?
Investigations in GI Bleeding
Indication of CT with angiography (CTA)
Procedure of CT with angiography (CTA)
Procedure of Radionuclide imaging
Indications of Radionuclide imaging
Types of Endoscopy in GI Bleeding
Types of Endoscopy in GI Bleeding
- Esaphagoduodenoscopy
Types of Endoscopy in GI Bleeding
- Colonoscopy
Endoscopic interventions to achieve hemostasis (successful in most cases)
Procedure of Capsule endoscopy
Indications of Capsule endoscopy
Other Procedures in Investigations GI Bleeding
Other Procedures in Investigations GI Bleeding
- NGT
Other Procedures in Investigations GI Bleeding
- Angiography
Other Procedures in Investigations GI Bleeding
- VC & Embolization
Other Procedures in Investigations GI Bleeding
- Balloon Tamponade
Other Procedures in Investigations GI Bleeding
- Surgery
Medications for UGIB
Medications for UGIB
- PPIs
Medications for UGIB
- PPIs (Examples)
Medications for UGIB
- PPIs (Dosing)
Medications for UGIB
- PPIs (advantages_
Medications for UGIB
- Prokinetic Drugs
Medications for UGIB
- Prokinetic Drugs (MOA)
Medications for UGIB
- Prokinetic Drugs (Drugs)
Medications for UGIB
- Vasoactive Meds
Medications for UGIB
- Vasoactive Meds (MOA)
Medications for UGIB
- Vasoactive Meds (Uses)
Medications for UGIB
- Antibiotics
Medications for UGIB
- Antibiotics (Indications)
Medications for UGIB
- Antibiotics (Drugs)
Medications for UGIB
- Non-Aspirin NSAIDs Should be Avoided
Common Causes of LGIB In Adults
Def of Angiodysplasia/AV Malformations
Sex in Angiodysplasia/AV Malformations
Age in Angiodysplasia/AV Malformations
RF for Angiodysplasia/AV Malformations
Incidence of Angiodysplasia/AV Malformations
CP of Angiodysplasia/AV Malformations
Site of Angiodysplasia/AV Malformations
MR of Angiodysplasia/AV Malformations
TTT of Angiodysplasia/AV Malformations
Types of IBD
CP of IBD
Extra-Intestinal Manifestations of IBD
CP & TTT of IBD
Incidence of Ischemic Colitis
RF for Ischemic Colitis
Sites of Ischemic Colitis
CP of Ischemic Colitis
TTT of Ischemic Colitis
Causes of Infectious Colitis
Pathogenesis of Infectious Colitis
CP of Infectious Colitis
CP of Neoplasms in LGIB
Sites of Neoplasms in LGIB
Incidence of Neoplasms in LGIB
Types of Neoplasms in LGIB
Types of Neoplasms in LGIB
- Benign
Types of Neoplasms in LGIB
- Malignant
Causes of LGIB in Children & Adolescents
Causes of LGIB
Incidence of Meckelβs Diverticulum
Site & Origin of Meckelβs Diverticulum
CP of Meckelβs Diverticulum
Cause of Bleeding in Meckelβs Diverticulum
Def of Intussuseption
CP of Intussuseption
INVx & TTT of Intussuseption
INVx in Anal Fissure
Baby + Vomiting + Bloody Stool + Tense Painful abdomen β-> β¦β¦..
TTT of Esophageal Varies
Vomiting & BPR are β¦. in intussessption
Bleeding PUD can cause Hemodynamic Instability