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ER 3 > LGI Bld > Flashcards

LGI Bld 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?

22
Q

What can mesneteric ischemia lead to?

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
SOC for LGI mesenteric ischemia
Angiography
26
Prognosis of Mesenteric ischemia/ischemic?
Poor 50 percent if DX w/in 24hrs
27
Meckel's diverticulum is?
Embryonic tissue of the terminal ileum that is paritally composed of ectopic gastric tissue which secretes gastric enzymes > erodes mucosal wall (bld)
28
Sources of chronic anemia w/ LGI Bld?
Polyps and carcnomas
29
What is the time frame for potential bleeding post polypectomy?
3wks
30
Left ventricular asssit pts are at risk of?
LGI bleed due to anticoag, AV malform risk, VonWillebrand disease
31
High morbidity rate factors?
``` NON-TTP ABD ASA/NSAID use (Diverticular bld) Hemo unstable RPT hematochezia Gross blood on rectal exam Crit <35 percent Syncope ```
32
Hx of aortic graft may indicate?
Aortoenteric fistula
33
What Rx increase LGI Bld risks?
Salicylates NSAIDS Warfarin
34
Injesting iron/bismouth may cause?
Melena mimic
35
LACK of ABD TTP may suggest?
bleeding involving vasculature (Diverticulosis/angiodysplasia)
36
IBD w/ LGI blds are ass/w what?
ABD TTP
37
BUN may be elevated in LGI BLD due to?
Hgb digestion/absorbtion
38
SOC for LGI Bld>
angiography - may ID bld and guide surgery (TXT/DX) scintigraphy - More SENS and at slower bld rate 0.1 or endoscopy
39
Angiography can DX/TXT how?
transcatherter arterial embolization or | V-Con infusion agents
40
What is a limitation of angiography?
Req brisk bleeding rate (at least 0.5mL/min)
41
What study can also localize bleeding?
Technetium labeled RBCs
42
Multidetector CT angiography os good for?
Determing bleed site prior to conventional angiography
43
LGI Bld TXT?
``` Resus, O2, Cardiac Monitoring 2 LRG bore IVs (replace w/ crystalloids) Correct coag Bld transfusiion PRN NG tube PRN if (UGI source) ```
44
Blood transfusion initiaion protocol?
After 2L crystalloids and pt is still bleeding/fail to improve perfusion/vitals
45
Flexible sigmoidoscopy can eval?
Distal colonic/rectal sources (Not proximal)
46
Colonoscopy an Dx?
Diverticulosis, angiodysplasia, ablation of bleeds
47
Admit LGI bleed pts if
Unstable/active bleed (ICU)
48
Higher M/M factors w. LGI bleed?
``` Hemo unstable RPT hematochezia w/in 4hrs eval Non-TTP ABD ASA >2 comorbids ```

ER 3 (6 decks)

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