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GI > Upper GI Bleeding > Flashcards

Upper GI Bleeding Flashcards

1
Q

Upper GI bleeding commonly presents with…

A
  • Hematemesis

- Melena

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2
Q

Upper and lower GI bleeding defined based on their location relative to…

A

Ligament of Treitz

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3
Q

Obscure bleeding

A

Hemorrhage that persists or recurs after negative endoscopy (source not apparent)

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4
Q

Occult bleeding

A

Hidden bleeding found accidentally

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5
Q

Shock

A

Organs and tissues of the body not receiving adequate blood flow allowing for buildup of waste products

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6
Q

Hypovolemic shock

A

Hemorrhagic

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7
Q

Stage I (compensated) of shock

A
  • Tachycardia
  • Vasospasm
  • Pt has few symptoms
  • Tx can halt
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8
Q

Stage II shock

A
  • Agitation, confusion, disorientation
  • Myocardial ischemia (w or w/o chest pain)
  • Decreased urine output
  • Tx reverse
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9
Q

Stage III shock

A
  • Heart fails
  • Kidneys fail
  • Circulatory collapse
  • End-organ damage
  • Death
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10
Q

Generalities of treating shock

A
  • Rapidly diagnose the state of shock
  • Diagnose the underlying condition
  • Quickly intervene to halt the underlying condition
  • Treat the effects of shock
  • Support vital functions
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11
Q

Initial assessment

A
  • ABCs (airway, breathing, circulation)
  • Stable/unstable?
  • Resuscitation
  • Oxygen
  • Trendelenburg position
  • IV
  • Blood transfusion
  • Urgent surgical consultation
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12
Q

BUN:Creatinine ratio suggestive of upper GI bleed

A

> 36:1

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13
Q

Signs and symptoms of shock

A
  • Systolic BP <100 mmHg
  • Pulse >100/min
  • Cool, clammy skin
  • Prolonged capillary refill
  • Changing mentation
  • Complaints of syncope/near-syncope
  • Decreased urine output
  • Narrowed pulse pressure
  • Hypotension
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14
Q

Positive orthostatics estimate how much loss of TBV

A

15-20%

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15
Q

Resting hypotension indicates how much loss of TBV

A

30-40%

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16
Q

ATLS guidelines for assessing shock patients

A

Any patient who is cool and tachycardic is in shock until proven otherwise

17
Q

Risk factors for morbidity and mortality in acute GI hemorrhage

A
  • Age >60 yr
  • Comorbid disease (renal failure, liver disease, respiratory insufficiency, cardiac disease)
  • magnitude of hemorrhage
  • Persistent or recurrent hemorrhage
  • Inpatient at time of bleed
  • Severe coagulopathy
  • Need for surgery
18
Q

Proton pump inhibitors

A
  • Start empirically prior to endoscopy
  • High dose IV (pantoprazole, lansoprazole, esomeprazole)
  • Can accelerate resolution of recent UGIB
  • Can decrease length of hospital stay
  • Significant reduction in risk of re-bleeding
  • Improvement in mortality
19
Q

PUD

A
  • Duodenal or gastric

- Imbalance between protective mucosa and acid/pepsin

20
Q

4 major risk factors for PUD

A
  • H. pylori infection
  • Use of NSAIDs
  • Physiologic stress
  • Excess gastric acid
21
Q

Clinical features of PUD

A
  • Epigastric pain
  • Gastric ulcers (pain 5-15 minutes after eating, relieved by fasting, high risk of malignancy)
  • Duodenal ulcers (pain 2-3 hours after eating, pain relieved temporarily by food, pain may wake at night, low risk of malignancy)
  • Epigastric tenderness
22
Q

Therapy for PUD

A
  • EGD
  • H2Blockers
  • PPIs
  • Sucralfate
23
Q

Treatment of H. pylori

A
  • Helidac therapy

- Prevpac therapy

24
Q

Aspirin and NSAIDs and GI bleed

A
  • Cause of both UGIB and LGIB
  • NSAIDs and ASA inhibit cyclooxygenase mediated PGD synthesis so impairs mucosal protection
  • High risk of bleeding in elderly w/o warning symptoms
25
Q

Other causes of PUD

A
  • Stress ulcers
  • Gastric acid
  • Esophagitis
  • Dieulafoy’s lesion
  • Malignancy
26
Q

Dieulafoy lesions

A

Large submucosal a. protruding through the mucosa (w/i fundus)
-More common in males

27
Q

Mallory-Weiss tears

A
  • Longitudinal tear near GE junction
  • Due to intense retching/vomiting
  • Tx supportive
28
Q

Cameron lesions/ulcers

A
  • Linear erosion/ulceration in the proximal stomach located at the end of a large hiatal hernia at the diaphragmatic pinch.
  • Thought to be due to mechanical trauma and local ischemia.
  • May present with overt bleeding.
  • Usually present as occult bleeding
  • Common cause of obscure bleeding.
  • Treatment is iron supplements and oral PPI.
  • Occasionally surgical repair of the hiatal hernia needed.
29
Q

Esophageal varices

A

-Due to portal hypertension
-High risk of mortality
-High risk of rebleed
-Medical management:
»Somatostatin
»Octreotide
-Endoscopic management:
»Sclerotherapy
»Band ligation
-Other:
»Sengstaken-Blakemore tube
»TIPS procedure
»Non-selective beta blocker
»PPI

30
Q

Class I hypovolemic shock

A
  • Up to 750 mL blood loss (up to 15%)
  • pulse <100
  • BP normal
  • Pulse pressure normal or increased
  • RR 14-20
  • Urine output >30 mL/hr
  • Mental status: slightly anxious
  • Crystalloid fluid replacement
31
Q

Class II hypovolemic shock

A
  • 750-1000 mL lost (15-30%)
  • pulse <100
  • BP normal
  • Pulse pressure decreased
  • RR 20-30
  • Urine output 20-30 mL/hr
  • Mental status: mildly anxious
  • Crystalloid fluid replacement
32
Q

Class III hypovolemic shock

A
  • 1500-2000 mL lost (30-40%)
  • pulse >120
  • BP decreased
  • Pulse pressure decreased
  • RR 30-40
  • Urine output 5-15 mL/hr
  • Mental status: anxious, confused
  • Crystalloid and blood replacement
33
Q

CLass IV hypovolemic shock

A
  • 2000 mL lost (>40%)
  • pulse >140
  • BP decreased
  • Pulse pressure decreased
  • RR >35
  • Urine output negligible
  • Mental status: confused, lethargic
  • Crystalloid and blood replacement
34
Q

Blatchford score

A
  • Often used for initial assessment

- any score >1 = admission

35
Q

Rockall score

A
  • Often used for risk assessment for re-bleeding or complications
  • 0-2 = low risk
  • > 8 = poor prognosis
36
Q

Stress ulcers

A
  • Multiple superficial erosions
  • High risk in ICU pt
  • Cushing’s ulcers (associated with head injury
  • Curling’s ulcers (associated with burns)
37
Q

Zollinger-Ellison syndrome

A

Increased production of gastric acid leading to destruction of natural mucosa

GI (8 decks)

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