Term
| What are the indiciations (4) for a patient with GI bleed to be admitted to the ICU (vs. the floor)? |
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Definition
- hemodynamic instability (+ orthostatic hypotension on PE)
- severe comorbidities
- acute bleed in pt > 60 yo
- acute bleed in pt with liver dz
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Term
| Initial management of a patient with acute GI bleed (4 - before or as you're admitting to ICU) |
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Definition
- 2 large bore (18 gauge) IVs
- NS (wide open)
- type and cross
- PPIs
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Term
| How does upper GI bleed generally present (2)? |
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Definition
- Melena (black, liquidy, foul smelling stool)
- Hematemesis (can be bright red or coffee grounds)
- Melena and hematemesis - requires 50 - 100 cc blood in UGI tract [to have hematochezia from UGI, must have > 1000 cc)
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Term
| DDx of upper GI blead (6), what are the two most common cause? |
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Definition
- peptic ulcer disease = #1 MC
- gastric erosion #2
- varices
- esophagitis
- Mallory Weiss tear
- malignancy
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Term
| top 2 causes of PUD, how do you treat #1? |
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Definition
- H. Pylori - tx is triple therapy with 2 antibiotics + PPI
- NSAIDs
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Term
| 5 (broad) causes of esophagitis |
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Definition
- GERD
- Infection: CMV, candida, HSV (all of these generally occur in immunosuppressed pt)
- meds: doxycycline, NSAIDs
- systemic/motor d/o: ex. scleroderma
- radiation
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Term
| how is management of esophageal varices different from management of other causes of GI bleed? |
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Definition
- It is one cause where transfusing can make the bleed worse (increases blood flow)
- Usually variceal bleeds are self-limiting
- Can give octreotide (somatostatin analog) to decrease blood flow to liver and decrease bleed
- Ultimate tx: endoscopic banding of varices. In refractory cases, do TIPS
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Term
| Common cause of lower GI bleed in older patient, how does it present |
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Definition
- diverticular bleed
- presents as PAINLESS bleeding (significant amount) with BRBPR (versus ischemic colitis - causes PAINFUL bleed)
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Term
| 3 general categories of causes of non-anion gap acidosis |
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Definition
- GI
- Renal (ex. RTA)
- Iatrogenic (too much normal saline)
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