Upper GI Bleed - Thackeray Flashcards
Hematemesis
Vomiting up blood or “coffee grounds”
Hematochezia
Bright red blood perructum
Melena
Black tarry stools
What are some obscure signs of GI bleeds?
-Sings of GI blood not seen directly:
Iron Deficiency Anemia Fatigue Pale Dyspnea Angina
What is initial Assessment/resuscitation for an upper GI bleed? (ON EXAM)
- Remember ABCs
- IV access - at least 2 large bore IVs
- Infusion: Crystalloid, Blood products
What is the diagnostic test of choice for upper GI bleed
EGD = esophagstroduodenoscropy (a.k.a. upper endoscopy)
What is the usual causes of esophageal varices?
Portal hypertension associated with liver disease/ cirrhosis
A guy come him with a history of alcoholism, DRAMATIC bleeding and hematemesis….. what is your first thought?
Esophageal varices!
What can you use to treat esophageal varices?
LOWER portal pressure!:
Octreotide or vasopressin
PPI - so acid isn’t bothering varices
Endoscopic procedure: Varcial band ligation
(TIPS/shunt if needed)
Out of hospital:
Non-selective B-blocker
What should you give to lower portal blood pressure in someone vomiting up blood from esophageal varices?
In hospital:
Octreotide
Vassopressin
Outpatient:
Non-selective B-blocker
What is the endoscopic procedure used to treat esophageal varices?
Variceal band ligation
Two big risk factors for peptic ulcer disease?
H. Pylori (4x more likely)
NSAIDS (3x more likely)
What if someone has H. pylori AND NSAID use?
Synergetic effect!!
15 x more likely!!!!!
Describe H. pylori
Small curved motile gram negative rod
Natural habitat is the stomach
Infection usually acquired in childhood
What tests can you use to diagnose H. pylori?
Breath test
Stool test
Serology
Biopsy
