Upper Gastrointestinal Bleeding

Question 1

Upper Gastrointestinal Bleeding (UGIB):

Saraiva, 2016

Answer 1

Intraluminal bleeding between the esophagus and the Treitz ligament

Question 2

Most common cause (Saraiva, 2016):

Answer 2

Peptic ulcer

Question 3

Substances that are risk factors:

Answer 3

Use of Alcohol, NSAIAs and anticoagulants

Question 4

Esophageal causes:

Answer 4

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

Question 5

Pathophysiology of the Non-variceal UGIB:

Answer 5

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

Question 6

Pathophysiology of the Variceal UGIB:

Answer 6

Portal hypertension -> Varices -> rupture -> UGIB

Question 7

Classification:

Answer 7

Non-variceal and Variceal

Question 8

Presentation:

Answer 8

Hematemesis, Melena, Hematochezia, Epigastric pain and Presyncope

Question 9

Most common symptom:

Answer 9

Melena (70-80%)

Question 10

Diagnostic procedures:

Answer 10

Nasogastric Lavage and Endoscopy

Question 11

When endoscopy should be performed?

Answer 11

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

Question 12

Forrest Endoscopic Classification:

Answer 12

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

Question 13

Diagnóstico Diferencial:

Answer 13

Hemorragia digestiva baixa

Question 14

Tratamento:

Answer 14

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

*Somatostatina ou Octreotide/Vapreotide

Question 15

Reposição volêmica:

Answer 15

SF 0,9% 1000-2000mL EV —> CH

Question 16

Terapia endoscópica:

Answer 16

Clipagem ou Escleroterapia

Question 17

Indicações de IBP:

Answer 17

Forrest 1a-2b

Question 18

IBP:

Answer 18

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

Question 19

Plaq -50.000:

Answer 19

Concentrado de Plaquetas

Question 20

Se INR+1,5:

Answer 20

PFC 4U ou PFC 10mL/kg

Question 21

Se uso de Heparina:

Answer 21

Protamina

Question 22

Se uso de warfarina:

Answer 22

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

Question 23

Indicações de profilaxia primária:

Answer 23

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

Question 24

Profilaxia primária:

Answer 24

Beta-bloqueador

Question 25

Indicações de profilaxia secundária:

Answer 25

a

Question 26

Profilaxia secundária:

Answer 26

Ligadura endoscópica ---> Beta-bloqueador + Nitrato

Question 27

Profilaxia para PBE:

Answer 27

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

Question 28

Escore de Blatchford:

Answer 28

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

Question 29

Risco de Ressangramento:

Answer 29

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

Question 30

Escore de Rockall:

Answer 30

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

Question 31

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

Answer 31

Pior prognóstico:

Question 32

Metas no uso de CH:

Answer 32

Hb +7 e Ht 25-30%

Question 33

Prevalence among male and female (Saraiva, 2016):

Answer 33

Most prevalent in males 2:1

Question 34

Age most affected (Saraiva, 2016):

Answer 34

Eldery

Question 35

Mortality ratio (Saraiva, 2016):

Answer 35

10-14%

Question 36

Diseases that are risk factors:

Answer 36

Gastric acidity, H,pylori infection, Hepatophaty and Nephrophaty

Question 37

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

Answer 37

Mallory-Weiss Syndrome

Question 38

Gastric causes:

Answer 38

Peptic ulcer (38%) and Dieulafoy's lesion

Question 39

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

Answer 39

Dieulafoy's lesion

Question 40

Intestinal causes:

Answer 40

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

Question 41

Laboratory studies:

Answer 41

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

Question 42

Spurting hemorrhage (Forrest):

Answer 42

Forrest IA

Question 43

Oozing hemorrhage (Forrest):

Answer 43

Forrest IB

Question 44

Visible vessel (Forrest):

Answer 44

Forrest IIA

Question 45

Adherent clot (Forrest):

Answer 45

Forrest IIB

Question 46

Flat pigmented haematin on ulcer base (Forrest):

Answer 46

Forrest IIC

Question 47

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

Answer 47

Forrest III

Question 48

Terlipressina:

Answer 48

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

Question 49

Escore de Blatchford +12:

Answer 49

EDA nas primeiras 3h