upper GI bleed HYHO Flashcards
what is the landmark of a UGI bleed?
from a source above the ligament of Treitz
The suspensory ligament of the duodenum
hypovolemic shock
inadequate circulating blood volume detected by the baroreceptor reflex
triggers increase heart rate and sympathetic stimulation with vasoconstriction of nonessential
organs. Blood is redirected away from skin, skeletal muscle, and the splanchnic circulation.
Patient appears cold, clammy and vasoconstricted. Signs of shock may appear with 30-40%
volume loss.
Peptic ulcer: symptoms
Upper abdominal pain
Esophageal ulcer symptoms :
Odynophagia, gastroesophageal reflux, dysphagia
Mallory-Weiss tear symptoms
Emesis, retching, or coughing prior to hematemesis
Variceal hemorrhage or portal hypertensive gastropathy: symptoms
Jaundice, abdominal
distention (ascites).
Bleeding from esophagogastric varcies is the single most life-
threatening complication of portal hypertension. It is responsible for 1/3 of all deaths in patients with cirrhosis.
Malignancy symptoms
Dysphagia, early satiety, involuntary weight loss, cachexia
what meds may cause peptic ulcer formation?
aspirin and other NSAIDS (ibuprofen, naproxen sodium, etc.)
what meds promote bleeding?
as antiplatelet agents (clopidogrel) and anticoagulants (warfarin)
what meds can turn stool black?
bismuth (pepto-bismol) and iron,
what should you check for in PE for UGI bleed?
x Vital signs (hemodynamic compromise , signs of shock)
x Confusion (may indicate lack of blood flow/oxygen to brain)
x Peripheral vasoconstriction—cool extremities, cyanosis
x Signs of liver disease (jaundice, ascites, caput medusa)
what labs should you get for UGI bleed?
x Complete blood count with differential (CBC with diff)
o Low platelets may hinder coagulation
x Coagulation studies (prothrombin time with INR), liver enzymes (AST, ALT), albumin, BUN and
creatinine
x Guiac testing of stool (evaluates for blood in stool which is not readily visible.)
at what levels of hemoglobin should you transfuse?
if hemogloblin is below 7 g/dl (low risk patients) or below 9 g/dl (high risk
patients – elderly, heart disease),
what values may be inaccurate with UGI bleed?
hemoglobin
what are the initial interventions for UGI bleed?
- 2 large bore IVES
- consider central line placement (in IVC)
- consider intubation (supplemental O2 before)
what are indications for a central line?
inadequate
peripheral venous access or infusion of materials that would be damaging to peripheral veins,
i.e. chemotherapy.
what fluids should be infused with blood is not available?
-crystalloid fluids
what fluids should be infused if blood products will be administered?
-NS
when do you give Fresh Frozen Plasma or Prothrombin Complex Concentrate
for international Normalized Ratio - INR >1.6
what should platelets be kept at if actively bleeding?
> 50,000 if actively bleeding
how many units of PRBC should you cross and match?
2-4 units
EGD (esophagogastroduodenscopy)
A camera is attached to a flexible hose that is
inserted into the patient’s oropharynx and advanced to identify the source of the bleed. Once
identified, other tools can also be utilized within the mechanism to inject medications or perform
procedures.
what is combined with sclerotherapy to decrease risk of rebleeding?
endoscopy with band ligation
what can be used as an alternative to sclerotherapy?
thrombotic agent
