T12: Upper GI Bleeding

Question 1

Hematemesis

Answer 1

bloody vomitus (lower in GI system), Appears fresh, bright red blood or “coffee grounds”

Question 2

melena

Answer 2

black, tarry stools; caused by digestion of blood in GI tract (went through digestive system), Black appearance—due to iron

Question 3

occult blood

Answer 3

undetectable by appearance; small amounts of blood in gastric secretions, vomitus, or stools

Question 4

occult blood is detectable by

Answer 4

guaiac test

Question 5

clay-colored

Answer 5

issue with gallbladder or liver

Question 6

common causes of UGI bleeding

Answer 6

Esophageal varices, BLUNT AND PENETRATING TRAUMA, liver disease, peptic ulcer disease, Drugs
o Aspirin, NSAIDs, corticosteroids, Plavix, Coumadin
Þ Sickle-cell anemia, DIC
Þ Stress-related mucosal disease (SRMD)
o Also called physiologic stress ulcers

Question 7

diagnostics for UGI bleeding

Answer 7

ENDOSCOPY IS PRIMARY TOOL
-angiography
-labs (CBC, BUN, electrolytes, PT, PTT, liver
-GUAIAC

Question 8

Massive upper GI hemorrhage is defined as

Answer 8

1500 mL of blood

Question 9

if a patient with a hemorrhage stops bleeding it means

Answer 9

CLOT HAS FORMED AT SITE AND THEY CAN TAMPONADE OFF, BUT IT CAN BLEED AGAIN

Question 10

Emergency Assessment and Management

Answer 10

o Immediate physical examination with focus on (can go into hypovolemic shock)
o Indwelling urinary catheter for assessment of hourly output (NEED TO WATCH THE KIDNEYS)
o Hemodynamic monitoring for accurate blood pressure assessment (A-line)
o Central venous pressure line for assessment of fluid volume status
o Supplemental oxygen
o Abdominal examination
o FLuids
o Endoscopic hemostasis therapy

Question 11

abdominal exam with UGI bleeding

Answer 11

• Presence or absence of bowel sounds
• Tense, rigid, boardlike abdomen: may indicate perforation and peritonitis

Question 12

fluids for UGI bleeding

Answer 12

volume is based on what they need
-Isotonic crystalloid- Lactated Ringers
-Volume replacement (based on what they need)
· Whole blood, packed red blood cells, fresh frozen plasma

Question 13

Endoscopic hemostasis therapy

Answer 13

-First-line therapy of upper GI bleed, locate bleeder and BURN IT
-Goal: to coagulate or thrombose the bleeding vessel

Question 14

Endoscopic hemostasis therapy interventions

Answer 14

NPO, HOB up, hydrate

Question 15

drug therapy for UGI bleed

Answer 15

-PPI, H2
-injection with epi during endoscopy for acute hemostasis (vasoconstricts quick)

Question 16

feedings

Answer 16

-initially clear fluids given hourly (parenteral nutrition)
- Gradually introduce foods as tolerated

Question 17

Hemorrhage that is result of chronic alcohol abuse…

Answer 17

Closely observe for DELIRIUM TREMENS

Question 18

delirium tremens s/s

Answer 18

• Agitation
• Uncontrolled shaking
• Sweating
• Vivid hallucinations (see ants and spiders)
• May be on withdrawal protocol
  · “When was your last drink?”
  · May give Haldol