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ER 3 > LGI Bld > Flashcards

LGI Bld Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

LGI Bld is where to Ligament of treitz?

A

Distal

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2
Q

LGI Bld in ER is always considered what until R/O?

A

Life threat

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3
Q

MC source of LGI Bld is

A

UGI Bld

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4
Q

MC source distal to ligament of treitz bleed is?

A

Diverticular disease ( then Colitis, polyps, maligs)

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5
Q

LGI Blds are more common in what POP?

A

Females (esp elderly)

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6
Q

How much LGI bleeding resolves spon?

A

80 percent

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7
Q

Hematochezia is?

A

Bright red/maroon rectal bleeding

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8
Q

If hematochezia is from UGI source that suggests?

A

Brisk bleeding (hematemesis/hemodynamiclly unstable)

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9
Q

Melena is?

A

Dark/black stools representing slow UGI source

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10
Q

LGI Bleed causes?

A

Diverticulosis
Vascular ectasia
Ischemia (and mesenteric ischemia)
Meckels diverticulum

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11
Q

Other less common causes of LGI Bld

A 
Infectious colitis
radiation colitis
rectal ulcers
trauma
IBD
Polyps/carcinomas
Hemorrohids
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12
Q

Diverticular bld is?

A

Painless and due to erosion of penetrating artery into diverticulum

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13
Q

MC side for diverticula is?

A

L-side (however R-side more likely to bleed)

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14
Q

Diverticula can be what in terms of volume of bleeding?

A

Massive (spon resolve 90 percent)

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15
Q

Vascular ectasia is?

A

Lrg/Sml bowl AV malformation and angiodysplasias

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16
Q

LRG bowl vascular ectasia is due to?

A

Chronic processw involving aging (inherited)

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17
Q

MC cause of intestinal ischemia?

A

Ischemic colitis (transient)

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18
Q

Colon is predispoded to ischemia why?

A

Poor vascularization and high bacteria content

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19
Q

What are RFs to colon ischemia?

A

ANything that slows motility or V-con the bowel

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20
Q

TXT of LGI Ichemia

A

Surgery (20 percent)

21
Q

DX of LGI ischemia is usually by?

A

Endoscopy

22
Q

What can mesneteric ischemia lead to?

A

Necrosis

23
Q

Causes of mesenteric ischemia?

A

thrombosis or embolism of superior mesenteric artery,
mesenteric venous thrombosis, and
nonocclusive mesenteric ischemia ass/w low arterial flow with v-con

24
Q

Dx of mesenteric is?

A

Difficult and req high suspicion esp in
>60yo
A-fib, CHF, Recent MI, unexplained wgt loss
Postprandial ABD pain

25
Q

SOC for LGI mesenteric ischemia

A

Angiography

26
Q

Prognosis of Mesenteric ischemia/ischemic?

A

Poor 50 percent if DX w/in 24hrs

27
Q

Meckel’s diverticulum is?

A

Embryonic tissue of the terminal ileum that is paritally composed of ectopic gastric tissue which secretes gastric enzymes > erodes mucosal wall (bld)

28
Q

Sources of chronic anemia w/ LGI Bld?

A

Polyps and carcnomas

29
Q

What is the time frame for potential bleeding post polypectomy?

A

3wks

30
Q

Left ventricular asssit pts are at risk of?

A

LGI bleed due to anticoag, AV malform risk, VonWillebrand disease

31
Q

High morbidity rate factors?

A 
NON-TTP ABD
ASA/NSAID use (Diverticular bld)
Hemo unstable
RPT hematochezia
Gross blood on rectal exam
Crit <35 percent
Syncope
32
Q

Hx of aortic graft may indicate?

A

Aortoenteric fistula

33
Q

What Rx increase LGI Bld risks?

A

Salicylates
NSAIDS
Warfarin

34
Q

Injesting iron/bismouth may cause?

A

Melena mimic

35
Q

LACK of ABD TTP may suggest?

A

bleeding involving vasculature (Diverticulosis/angiodysplasia)

36
Q

IBD w/ LGI blds are ass/w what?

A

ABD TTP

37
Q

BUN may be elevated in LGI BLD due to?

A

Hgb digestion/absorbtion

38
Q

SOC for LGI Bld>

A

angiography - may ID bld and guide surgery (TXT/DX)
scintigraphy - More SENS and at slower bld rate 0.1
or endoscopy

39
Q

Angiography can DX/TXT how?

A

transcatherter arterial embolization or

V-Con infusion agents

40
Q

What is a limitation of angiography?

A

Req brisk bleeding rate (at least 0.5mL/min)

41
Q

What study can also localize bleeding?

A

Technetium labeled RBCs

42
Q

Multidetector CT angiography os good for?

A

Determing bleed site prior to conventional angiography

43
Q

LGI Bld TXT?

A 
Resus, O2, Cardiac Monitoring
2 LRG bore IVs (replace w/ crystalloids)
Correct coag
Bld transfusiion PRN
NG tube PRN if (UGI source)
44
Q

Blood transfusion initiaion protocol?

A

After 2L crystalloids and pt is still bleeding/fail to improve perfusion/vitals

45
Q

Flexible sigmoidoscopy can eval?

A

Distal colonic/rectal sources (Not proximal)

46
Q

Colonoscopy an Dx?

A

Diverticulosis, angiodysplasia, ablation of bleeds

47
Q

Admit LGI bleed pts if

A

Unstable/active bleed (ICU)

48
Q

Higher M/M factors w. LGI bleed?

A 
Hemo unstable
RPT hematochezia w/in 4hrs eval
Non-TTP ABD
ASA
>2 comorbids

ER 3 (6 decks)

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