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Medicina de Emergência > Upper Gastrointestinal Bleeding > Flashcards

Upper Gastrointestinal Bleeding Flashcards

1
Q

Upper Gastrointestinal Bleeding (UGIB):

Saraiva, 2016

A

Intraluminal bleeding between the esophagus and the Treitz ligament

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2
Q

Most common cause (Saraiva, 2016):

A

Peptic ulcer

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3
Q

Substances that are risk factors:

A

Use of Alcohol, NSAIAs and anticoagulants

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4
Q

Esophageal causes:

A

Erosive esophagitis (15%), Esophagus varices, Ectopic varices and Mallory-Weiss Syndrome

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5
Q

Pathophysiology of the Non-variceal UGIB:

A

Esophageal/Gastroduodenal mucosa lesion -> erosion/ulceration -> UGIB

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6
Q

Pathophysiology of the Variceal UGIB:

A

Portal hypertension -> Varices -> rupture -> UGIB

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7
Q

Classification:

A

Non-variceal and Variceal

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8
Q

Presentation:

A

Hematemesis, Melena, Hematochezia, Epigastric pain and Presyncope

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9
Q

Most common symptom:

A

Melena (70-80%)

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10
Q

Diagnostic procedures:

A

Nasogastric Lavage and Endoscopy

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11
Q

When endoscopy should be performed?

A

First 24h after the UGIB, immediately after endotracheal intubation (if indicated) and hemodynamic stabilization

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12
Q

Forrest Endoscopic Classification:

A

Acute hemorrhage (Ia e Ib), Signs of recent hemorrhage (IIa, IIb e IIc) and Lesions without active bleeding (III)

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13
Q

Diagnóstico Diferencial:

A

Hemorragia digestiva baixa

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14
Q

Tratamento:

A

MOV -> Reposição volêmica -> Terapia endoscópica —> Terlipressina —> Balão esofágico —> Corrige coagulopatia —> TIPS —> Cirurgia ou Embolização transcutânea

*Somatostatina ou Octreotide/Vapreotide

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15
Q

Reposição volêmica:

A

SF 0,9% 1000-2000mL EV —> CH

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16
Q

Terapia endoscópica:

A

Clipagem ou Escleroterapia

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17
Q

Indicações de IBP:

A

Forrest 1a-2b

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18
Q

IBP:

A

Omeprazol 80mg EV em bolus -> 8mg/h por 72h

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19
Q

Plaq -50.000:

A

Concentrado de Plaquetas

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20
Q

Se INR+1,5:

A

PFC 4U ou PFC 10mL/kg

21
Q

Se uso de Heparina:

A

Protamina

22
Q

Se uso de warfarina:

A

Complexo protrombínico (Fatores II, VII, IX e X)

23
Q

Indicações de profilaxia primária:

A

Varizes de grosso calibre ou médico c/ red spots e Child C

24
Q

Profilaxia primária:

A

Beta-bloqueador

25
Q

Indicações de profilaxia secundária:

A

a

26
Q

Profilaxia secundária:

A

Ligadura endoscópica —> Beta-bloqueador + Nitrato

27
Q

Profilaxia para PBE:

A

Norfloxacino 400mg VO 12/12h por 7d ou Ciprofloxacina EV

28
Q

Escore de Blatchford:

A

Hb -13(h) ou -12(m), PAs -110, FC +100, Ur +30, melena, síncope, cardiopatia e hepatopatia

29
Q

Risco de Ressangramento:

A

Id +65a, Comorbidades, Choque, Hb -10, Ht-30% e Necessidade de Transfusão

30
Q

Escore de Rockall:

A

Antes da esdoscopia (0-7pts) e depois (0-8pts)

31
Q

Idade, Comorbidades, Origem varicosa, Sangramento ativo à EDA, Ulcera +2cm, Hematêmese/Enterorragia, Internado, Hipotensão/Choque, Cirurgia e no. de Transfusões:

A

Pior prognóstico:

32
Q

Metas no uso de CH:

A

Hb +7 e Ht 25-30%

33
Q

Prevalence among male and female (Saraiva, 2016):

A

Most prevalent in males 2:1

34
Q

Age most affected (Saraiva, 2016):

A

Eldery

35
Q

Mortality ratio (Saraiva, 2016):

A

10-14%

36
Q

Diseases that are risk factors:

A

Gastric acidity, H,pylori infection, Hepatophaty and Nephrophaty

37
Q

Esophageal bleeding caused by a mucosal tear in the esophagus as a result of forceful vomiting or retching:

A

Mallory-Weiss Syndrome

38
Q

Gastric causes:

A

Peptic ulcer (38%) and Dieulafoy’s lesion

39
Q

Large tortuous arteriole in the stomach wall that erodes and bleeds:

A

Dieulafoy’s lesion

40
Q

Intestinal causes:

A

Duodenal ulcer, Angiodisplasia of the gastrointestinal tract, Aortoenteric fistula and Neoplasia

41
Q

Laboratory studies:

A

HC, Tipagem, Coagulograma, Eletrólitos, Glicemia, Função renal e hepática

42
Q

Spurting hemorrhage (Forrest):

A

Forrest IA

43
Q

Oozing hemorrhage (Forrest):

A

Forrest IB

44
Q

Visible vessel (Forrest):

A

Forrest IIA

45
Q

Adherent clot (Forrest):

A

Forrest IIB

46
Q

Flat pigmented haematin on ulcer base (Forrest):

A

Forrest IIC

47
Q

Lesions without signs of recent hemorrhage or fibrin-covered clean ulcer base (Forrest):

A

Forrest III

48
Q

Terlipressina:

A

1-2mg EV 4/4h por 3-5d

49
Q

Escore de Blatchford +12:

A

EDA nas primeiras 3h

Medicina de Emergência (59 decks)

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