Thackeray: Upper GI Bleeds Flashcards
How do you identify a pt w/ an upper GI bleed?
- GI blood loss (hematochezia- blood rectum, melena- slowly blood stool, hematemesis, volume loss)
- Obscure signs of GI bleeding not seen directly (IDA, fatigue, pale, dypsnea, angina)
How do you manage a pt w/ an upper GI bleed?**
INITITAL ASSESSMENT AND RESUSCITATION***
- ABCs (airway, CPR)
- IV access (2 large bore IVs–give volume back)
- Infusion (crystalloid, blood products)
SECONDARY ASSESSMENT
- lab studies (Hb 13 vs 6)
- Underlying pt conditions (severe cardiac disease- can’t afford Hb of 6, liver disease, coagulopathy)
- monitor vital signs
- determine appropriate level of care (hospital vs home, ICU vs floor)
What are common and uncommon causes of upper intestinal bleeding?
Common: esophagus, stomach, small bowel
Uncommon: bile ducts, liver, pancreas
What is the test of choice for diagnosing an upper GI bleed?
Upper endoscopy (EGD= esophagogastroduodenoscopy)
What are common causes of esophageal bleeding?
VARICES**
esophagitis
mallory weiss tear
tumors
**An alcoholic presents with dramatic bleeding and hematemesis.
Varices** are associated w/ liver disease and cirrhosis, which would both BLOCK blood from returning to the IVC leading to portal hypertension.
Blood then is pushed back through the hepatic portal vein to the left gastric vein and can cause esophageal varices!
How do you treat varices?
Octreotide or Vasopressin
Proton Pump inhibitor (decrease acid levels)
Non-selective Beta-blocker (decrease systemic pressure)
Variceal band ligation
TIPS/Surgical shunt
A pt presents w/ odynophagia, dysphagia, hematemesis.
Esophagitis (inflammation of the stomach) is either caused by acid exposure or things getting stuck in the esophagus (pill impaction or food impaction)
It’s associated w/ REFLUX cause then you’re getting a helluva lotta acid exposure.
How do you tx esophagitis?
Decrease the acid or make sure things don’t get stuck!
PPI
lifestyle modification (less acid coming back into the esophagus)
soft diet
A young college student who has been vomiting/retching b/c they’re hung over presents w/ hematemesis and odynophagia.
Mallory Weiss Tear is a small mucosal tear that usually occurs at the gastro esophageal junction.
How do you tx a Mallory Weiss Tear?
Usually stops spontaneously
PPI
What are common causes of stomach bleeding?
ULCERS* gastritis vascular ectasis dieulafoy lesions varices tumors
What is an ulcer?
break in the mucosa WITH DEPTH, may involve the submucosa
What is an erosion?
scarping the skin
break in the mucosa WITHOUT DEPTH
What is peptic ulcer disease?
ulcer or erosion in the stomach or duodenum
What are RF/main causes of peptic ulcer disease?
- H. pylori** (x4)
2. NSAIDS ** (x3)
How do you treat peptic ulcer disease caused by h. pylori?**
Treatment usually lasts for 2 weeks, and then you should test to make sure that it’s been eradicated (breath or stool)**. If it fails it’s usually d/t noncompliance.
Triple therapy (2 ABs + PPI)= clarithro+ amox+ PPI
Quadruple tx (2 ABS + bismuth + PPI)
How do NSAIDS cause peptic ulcer disease?
PGs in the gut regulate mucus and bicarb secretion. NSAIDS inhibit COX and decrease PG production
A pt presents with a burning epigastric pain that is worse with eating. As well as belching, bloating, nausea and feelings of early satiety.
Gastric ulcer
A pt presents with burning epigastric pain that improves w/ eating?
duodenal ulcer
How do you treat a young pt w/ a peptic ulcer who doesn’t have alarming symptoms
trial of empiric anti-ulcer therapy with close follow up
non-invasive testing for H.pylori and treatment when appropriate (serology, breath, stool)
definitive diagnostic eval (imaging/endoscopy)
What is vascular ectasis?
superficial blood vessels that can bleed
What is a dieulafoy lesions?
submucosal artery that can bleed (someone who comes in bleeding over and over)
What are common cuases of duodenal bleeding
ulcers
vascular malformations- arteries and veins that connect come to surface of bowel–clip–destroy vessel
tumors
What are common causes of lower GI bleeding?
Diverticular bleed Tumor Vascular Malformation Post-polypectomy Ulcer
