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Acute Bleeding GI
Acute Bleeding GI
25
Accounting
Pre-School
02/10/2011

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Cards

Term
T/F: bleeds outside hospital have better outcomes than bleeds inside hospital
Definition
T: because pts that bleed in hospital are sicker
Term
T/F: Outcome of GI bleeding does not depend on comorbid diseases
Definition
F - 0, 1, 2, 3 comorbidities => inc mortality
o Mortality 3.5-7% for UBIB, LGIB 3.6% (upper > lower)
Term
T/F: endoscopy is only reserved for very few special cases
Definition
F: o Most pts get scoped with UGIB within 24hrs
 20-35% include endoscopic therapy
Term
Three O's of GI Bleeding
Definition
o Over: can see it
o Occult: hidden
o Obscure: bleeding, but don’t know where it’s coming from
Term
T/F: If a patient has orthostatis <90, you should immediately start transfusing blood.
Definition
F: Start IV fluids first...but know that

 ORTHOSTASIS < 90 systolic: worse morbidity and mortality – KNOW THIS!
• Rule: Hypotensive bleeds (upper or lower) define outcome
Term
What are the cut offs for Hgb/Hct in young and infirm px?
Definition
 Hgb/Hct
• Young pts: approximately 7/20
• old/infirm….approx 10/30
Term
T/F: Pts with bright red blood in the stools could have an upper GI bleed.
Definition
T: Especially if there's a brisk bleed in duodenum and lavage comes back negative for upper GI bleed. Upper source must be found so it can be treated with upper endoscopy.
Term
What meds are risk factors for bleeding?
Definition
warfarin, NSAIDs, antiplatelets
Term
Signs of Upper GI Bleed?
Definition
 Upper:
• Melena, burgundy stool, hematemesis
• May have elevated BUN, but may be due to dehydration
• Massive UGIB may have red blood from below
Term
Lower GI bleed signs?
Definition
 Lower: hematochezia
• Remember: most LGIB of diverticular origin stop on their own
Term
If you suspect an esophageal source of bleeding, what can it be due to?
Definition
esophagitis/ulcer (reflux, infectious, pill), varices (portal htn,cirrhosis), cancer, Mallory Weiss tear (from retching)
Term
If you suspect a stomach source of bleeding, what can it be due to?
Definition
ulcer/erosion (H. pylori, NSAIDs/aspirin), Mallory Weiss (could also be in cardia), Dieulafoy lesion (artery that never tapers), varices, cancer, AVMs/GAVE
Term
If you suspect a duodenal source of bleeding, what can it be due to?
Definition
ulcer/erosion, angiodysplasia, dieulafoy, cancer (ampullary, duodenal), less common (hemobilia, hemosuccus pancreaticus, aortoenteric fistula)
o Note: cancer rarely presents with acute upper GI bleed
Term
If you suspect a small bowel source of bleeding, what can it be due to?
Definition
ANGIODYSPLASIA/AVM (hemodynamically stable, melena and either renal insufficiency, heart valve disease, portal HTN or HHT), Dieulafoy (recurrent, obscure bleeding), NSAIDs/ASA, Crohn’s, hemangioma, cancer, Meckel’s
Term
If you suspect a colonic source of bleeding, what can it be due to?
Definition
diverticulosis (brisk bleed, painless, older pts), angiodysplasia (slow ooze), hemorrhoids (can be brisk, BRB on TP, unlikely if hypotensive), fissure (pair with defecation), ischemia, infectious, inflammatory, radiation, cancer, NSAIDs/ASA, rectal ulcer, portal HTN
Term
Dieulafoy's lesion
Definition
is a medical condition characterized by a large tortuous arteriole in the stomach wall that erodes and bleeds. It can cause gastric hemorrhage[1] but is relatively uncommon. It is thought to cause less than 5% of all gastrointestinal bleeds in adults.
Term
Mallory–Weiss syndrome or gastro-esophageal laceration syndrome
Definition
refers to bleeding from tears (a Mallory-Weiss tear) in the mucosa at the junction of the stomach and esophagus, usually caused by severe retching, coughing, or vomiting.
Term
T/F: volume contraction means small vessel bleeding (ulcers < diverticuli < AVM)
Definition
F: volume contraction means large vessel bleeding (ulcers > diverticuli > AVM)
Term
When and why would you put a nasogastric tube into a GI bleeding px?
Definition
• Reasonable when suspected upper source or if unclear
• Can determine if source is stomach (and maybe duodenum)
• Can determine if bleeding is active
• Can give clue to rate of bleeding
• Can irrigate and clean stomach prior to endoscopy
Term
T/F: Hemoccult are a mainstay of determining GI bleeds
Definition
F: • Hemoccult cards are designed for colon cancer screening
• For GI bleeds, rely on whether you see blood, NOT on hemoccult card
• Hemoccult positivity ≠ GI bleed
Term
Describe the steps of endoscopy:
Definition
• Injection: epinephrine, sclerosant (sodium morrhuate) – varices, glue
• Thermal: APC (argon plasma coagulation), bipolar or monopolar cautery
• Banding
• Clipping
• Segstaken-Blakemore balloon - varices
Term
What drugs can we give for acute GI bleeds?
Definition
PPI (good for acute GI bleed from ulcer), H2RA, sandostatin
Term
During the endoscopy you see stigmata from ulcers. What is this and how do you prevent this?
Definition
Could be due to: spurting arterial bleeding (85-100% rebleed), non-bleeding visible vessel, adherent clot, others, no stigmata (i.e. no visible signs of bleeding)
Prevent with: PPI, beta-blocker, manage risk (NSAIDs, ASA, warfarin, clopidogrel)
o Ulcers: medical therapy
Term
You see a red wale, white spot, clot on endoscopy...what is this and how to treat?
Definition
Varices...
beta-blockade + banding
Term
. If pt vomited without blood first, then started bleeding...what is it?
Definition
mallory weiss tear
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