Lec 8 GI Bleed Flashcards
What does hematemesis suggest about location of bleed?
suggests upper GI blled
What does coffee ground emesis suggest about location of bleed?
suggests upper
What is melena?
thick black tarry stool containing blood
What does melena suggest about location of bleed?
almost always upper GI blled; but 10% from small bowel or proximal colon
What is hematochezia? what does it suggest about location of bleed?
bright red blood per rectum
usually due to lower GI bleed; or could indicate massive upper GI blled
What vital signs do you see in GI bleed?
hypotension and tachycardia from hypovolemia due to blood loss
What do you see on labs in GI bleed?
- if acute: hematocrit % may not fall immediately b/c you lose whole blood
- high BUN especially in upper GI
What does high BUN suggest?
upper GI bleed
WHen can you get false neg NG tube lavage? false positive?
false neg: tube coiled in stomach, bleed from duodenum
false pos: blood from trauma of passing the tube
What are common causes of upper GI bleed?
- aspirin/NSAId –> peptic ulcer, gastritis, duodenitis
- liver disease –> varices
- preceding retching –> mallory weiss
- GERD –> esophagitis
- previous aortic aneurysm surgery –> aorto-enteric fistula
- noeplasm
What are signs of overt bleeding?
hematemesis, melena, hematochezia; red blood on toilet paper
What are signs of occult bleeding?
microscopic blood in stool over wks to mos –> produces microcytic anemia and iron deficiency
What constitutes upper GI?
duodenum and more proximal
aka proximal to ligament of trietz
What are danger signs with peptic ulcer bleed?
- shock
- age > 60
- comorbidities
- melena + hematochezia
- active bleeding
What is treatment for bleeding peptic ulcer?
IV fluid resuscitation
IV proton pump inhibitors
Are gastritis bleeds life threatening?
not usually
Does neoplasia more commonly present as occult or overt bleed?
more commonly occult
What is gastric antral vascular ectasia [GAVE]? another name?
called “watermelon stomach”
dilated mucosal vessels; more common in pts with renal problem or in elderly
cause of upper GI bleed
What is a dieulafoy lesion?
large caliber artery entering mucosa –> causes significant bleed with small erosions; can start and stop
cause of upper GI bleed
What are cameron lesions?
erosions or ulcerations that occur within a hiatal hernia
usually lead to iron deficiency anemia rather than hematemesis/melena
What are most common causes of lower GI bleed?
- hemorrhoid
- fissure
- colitis
- polyp
What do you see in bleeding hemorrhoid?
painless blood on tissue or in bowl
What do you see w/ fissure clinically?
tearing/ripping as bowel movement passes anal canal
What do you see with colitis clinically?
urgency, tenesmus, diarrhea, mucus
What do you see when polyp causing GI bleed?
blood mixed with stool
What are 2 acute causes of lower GI bleed?
- diverticulosis
- arteriovenous malformations
What are major causes of “obscure” GI bleeding?
- small intestine: vascular, neoplastic [primary adenocarcinoma, lymphoma, metastatic disease], inflammatory [crohns], meckels
What is nuclear scan for meckels
- inject TC-99m which accumulates in gastric mucosa by binding parietal cells
can see heterotopic gastric mucosa in most meckels
What is advantage of double balloon enteroscopy?
- can see the whole bowel and give therapy
- w/ capsule can see whole bowel but can’t treat
