Week 5 - Upper GI Bleed Flashcards
where can an upper GI bleed occur (3)
- esophagus
- stomach
- duodenum
what can cause upper GI bleeds (2)
- drugs
- systemic diseases
what kind of drugs can cause upper Gi bleeding (3)
- NSAIDs
- salicylates
- corticosteroids
what are some causes of an esophageal upper GI bleed (3)
- esophageal varices
- esophagitis
- mallory-weiss tear (often d/t chronic vomitting)
what are some causes of stomach & duodenum upper GI bleeds (5)
- gastric cancer
- hemorrhagic gastritis
- peptic ulcer disease
- polyps
- stress ulcer
what are some systemic diseases that can cause upper GI bleeds (3)
- blood dyscrasias
- renal failure
- liver failure
what are signs of an upper GI bleed (3)
- emesis –> coffee ground or hematemesis
- melena
- abdominal pain
what can an upper GI bleed lead to
- shock (esp. if dont replace fluids quickly)
what is hematemesis
- vomitting of bright red blood
what does hematemesis indicate
- the blood has not come in contact with the stomach’s acid secretions
= bleed above stomach
what is coffee ground emesis
- vomiting of dark brown, granular material that resembles coffee grounds
what does coffee ground emesis indicate
- the blood has been in contact with the stomach and has changed by contact with gastric secretions
what is melena
- black, tarry stools
what does melena indicate
- slow bleeding from an upper GI source
- the longer the passage of blood thru the intestines = more darker as result of degradation of hgb
what can be used to diagnose an upper GI bleed (2)
- endoscopic procedures to identify sources of bleeding thru direct visualization
- angiography if endoscopy cant be done
barium studies not super helpful in indentifying bleeding sites during acute phase
what is important to note when completing emergency assessment and management of upper GI bleed (3)
- most stop spontaneously
- cause must be identified and treatment initiated immediately
- complete history imp to discover cause, but defer til after emergency care is implemented
what interventions are used to stabilize a pt with an upper GI bleed (12)
- treat like and look for S&S of hypovolemia shock
- calm approach
- frequent VS (BP, pulse) q 15-30 min
- O2 & resp assessment
- establish 2 Ivs
- IV fluids & monitor for fluid overload
- monitor I&O, urine output
- monitor stool & emesis
- lab work (electrolytes may be imbalanced)
- monitor peripheral perfusion & cap refill
- abdomen assessment: rigidity (peritonitis or perforation)
- monitor hct & hgb q 4-6h
what are 3 different categories of collaborative care for an upper GI bleed
- endoscopic therapy (primary treatment procedure)
- surgical
- drug
what is the goal of endoscopic hemostasis
- identify and stop the bleeding
what are 3 different endoscopic methods used for upper GI bleeds
- sclerosing needles
- endoclips
- electrocoagulation probes
describe what and how sclerosing needles work
- sclerosing needles passed thru endoscope
- then meds (ex. epi) or glue are injected to stop the bleeding
describe how endoclips work
- endoclips passed thru endoscope
- then used to clamp off the bleeding area
describe how electrocoagulation probes work
- heat of the probe coagulates the tissue directly on the bleeding site
when is surgical intervention indicated
- if bleeding continues regardless of therapy provided
- and the site of bleeding has been identified
in the acute phase, drugs are used to…
- decreasing bleeding
- decrease HCl secretion
- neutralize HCl
drugs to decrease bleeding are administered how?
- endoscopically
list some meds used for treatment of upper GI bleed (5)
- octreotide (sandostatin)
- vasopressin
- antacids
- PPIs
- H2 receptor blockers
what does vasopressin do
- produces vasoconstriction
what is important to monitor/consider w vasopressin
- constricts other vessels
= risk of decreased myocardial contractility, decreased coronary blood flow, can cause myocardial, peripheral, visceral ischemia
why is it helpful to reduce acid secretion in treatment of an upper GI bleed
- the acidic enviro can alter platelet function & interfer w clot stabilization
what do H2R blockers do
- inhibit action of histamine at H2 receptors on parietal cells & decrease acid secretion
what is are 2 examples of a type of H2R blockers
- ranitifine (zantac)
- famotidine (pepsid)
what are PPIs
- proton pump inhibitors
- inhibit cellular pump which is imp for acid secretion
what is an example of a type of PPI
- omeprazole (Losec)
what do anatacids do
- neutralize HCl & increase pH of gastric contents
what is an example of an antacid
- aluminum hydroxide (amphogel)
what is octreotide (sandostatin)
- somatostatin anolgue
- reduces blood flow and acid secretion
list imp pt teaching to a pt with /after an upper GI bleed (4)
- note: pt who has had one bleeding episode is likely to have another*
- avoid gastric irritants
- decrease stress-inducing situations
- caution w OTC meds (may contain ASA, etc.)
- if pt on ulcerogenic drugs, educate of potential adverse effects these have on GI mucosa
what are some examples of gastric irritants to avoid in a pt with upper GI bleed (2)
- smoking
- alcohol
what type of meds should you use caution in administering to a pt with upper GI bleed? why>
- sedatives
- restlessness is a warning sign of shock, so these meds can mask that
