OnlineMedEd: Gastroenterology - "GI Bleed" Flashcards
True or false: hematochezia (bright red blood from the rectum) may be caused by an upper GI bleed.
True
The difference is, though, that the person needs to lose a lot of blood from an upper GI bleed in order to have hematochezia. They will thus probably look a lot sicker than the person with a lower GI bleed having hematochezia.
List the causes of an upper GI bleed.
- Epistaxis
- GERD
- Varices
- Esophageal or stomach cancer
- Arteriovenous malformation
__________ is always a sign of an upper GI bleed.
Hematemesis
The rate of perfusion is determined by _______________.
the length of the catheter
With all GI bleeds (whether upper or lower) you do the same five things: _______________.
- Start two large bore IVs
- Transfuse IVF
- IV PPI
- Type and cross blood (transfuse as needed)
- Page GI
If a person with a GI bleed has cirrhosis, then you need to give _______________.
octreotide and ceftriaxone
____________ used to be part of the workup of GI bleeds, but because it is not sensitive it is no longer done (in fact, 30% of upper GI bleeds will test negative).
Nasogastric lavage
Instead of NG lavage, ____________ is now the standard workup for GI bleeds.
EGD
List the causes of a lower GI bleed.
- Colon cancer
- Arteriovenous malformation
- Diverticular hemorrhage
- Hemorrhoid
For brisk lower GI bleeds, _____________ is better than colonoscopy.
arteriogram (which can embolize)
Colonoscopy can get obscured by brisk bleeding.
How should you manage varices?
- First, in a person with GI bleeding who has cirrhosis, prophylactically give octreotide and ceftriaxone (while also going through the “first five” for all GI bleeds).
- Second, do an EGD to definitively diagnose.
- Third, temporarily stabilize with banding or balloon.
- Fourth, treat with propranolol or nadolol.
- Fifth, definitively treat with transplant (TIPS can be used as an intermediate).
True or false: those with Mallory-Weiss tears need to have surgery.
False
Because these are not transmural, they resolve on their own so long as the person can stop vomiting.
How can you differentiate Mallory-Weiss tears from Booerhave’s syndrome?
Mallory-Weiss tears are going to be found in someone who has vomited a couple times recently (and very forcefully). Booerhave’s syndrome will be seen in someone with a long history of vomiting –alcoholics or bulimics.
Review the process of diagnosing Booerhave’s syndrome.
- Start with a gastrograffin swallow. (This is a contrast that is water soluble and will thus not cause as many issues as barium in the mediastinum.)
- If the gastrograffin was negative, then do a barium swallow.
- Finally, if the barium swallow was also negative, then do an EGD. (You don’t start with an EGD because you might push the camera into the tear.)
What is Dieulafoy’s malformation?
It is a normal anatomical variant in which an artery is too close to the surface of the upper GI mucosa. Small erosions can break into it and cause bleeding.
Describe a Sitz bath.
Used to relieve perineal itchy, irritation, and pain (often from hemorrhoids), Sitz baths are warm-water baths that you sit in.
Mesenteric ischemia presents with what findings?
- A benign abdominal exam (i.e., soft, non-distended, no organomegaly, negative Murphy’s and McBurney’s)
- Pain out-of-proportion to the physical exam
- History of vasculopathy
- Definitive diagnosis with angiogram
AVMs are associated with what other problem?
Aortic stenosis
How is ischemic colitis different from mesenteric ischemia?
Ischemic colitis is a sudden death of bowel due to hypoperfusion (such as from shock or dehydration).
