Term
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Definition
| vomiting of blood or coffee-ground-like material |
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Term
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Definition
black-colored stool;
can occur w/ bleeding anywhere in GI tract |
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Term
|
Definition
bright red blood per rectum (BRBPR);
indicative of LOWER GI bleed |
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Term
| Fecal Occult Blood Test (FOBT) |
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Definition
identifies presence of Hgb in still;
guaiac-based |
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Term
|
Definition
weakness/fatigue;
hematemesis;
melena;
hematochezia; |
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Term
| Non-variceal Upper GI Bleed (UGIB) |
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Definition
Caused by:
1) PUD:
- single vessel
- Sx: hematemesis, weakness/fatigue;
- any part of stomach
- 12% mortality rate;
2) Stress-related Mucosal Damage (SMRD-"stress ulcer"):
- multiple capillaries
- asymptomatic
- in proximal stomach
- 50% mortality rates |
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Term
| Variceal Upper GI Bleed (UGIB) |
|
Definition
most common complication of liver cirrhosis/ESLD;
Predictors:
- size of varices
- location of varices
- decompensated cirrhosis
- appearance (red whale marks on endoscopy, cherry red spots, hematocystic spots)
Acute: bleeding <6 wks
Late: >6 wks |
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Term
|
Definition
1) Short-term Abx: gram-Neg coverage (norfloxacin, ciprofloxacin) x 7 days;
2) Splanchnic Vasoconstrictors (vasopressin, NTG)
3) Somatostatin Analogs (octreotide, somatostatin) |
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Term
norfloxacin 400 mg PO BID;
ciprofloxacin 400 mg IV BID;
ceftriaxone 1 g IV/IM if at risk for FQN resistance |
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Definition
short-term antibiotic (use <7 days);
Used to prevent severe bacterial infection (UTI, SBP, pneumonia, bacteremia);
Have good Gram-Neg coverage; |
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Term
|
Definition
MoA: constricts mesenteric arterioles;
Dose:
- 0.4 unit bolus, then 0.2-0.4 units/min IV infusion; MAX dose: 1 unit/min; MAX duration: 24 hrs;
ADRs:
- cardiac, peripheral, cerebral, & bowel ischemia;
- arrhythmias;
- increase in BP;
Inferior to somatostatin analogs - NOT used in variceal GIB;
**Use w/ NTG IV infusion** |
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Term
|
Definition
Dose: 40-400 mcg/min;
Titrate to SBP >90 mmHg |
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Term
|
Definition
somatostatin analog;
MoA: inhibits release of vasodilatory hormones (glucagon);
Duration of Use: 3-5 days;
Dose: 50 mcg IV bolus, then 50 mcg/hr |
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Term
| Secondary Prophylaxis of UGIB |
|
Definition
Pharm Therapy:
1) Non-selective Beta-Blocker (propranolol, nadolol)
+/-
2) Nitroglycerin (NTG) - adjunctive therapy if Beta-Blockers not achieving goals;
Surgery: Transjugular Shunt (TIPS) |
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Term
| Treatment Approach to UGIBs |
|
Definition
1) Classify Risk for Rebleeding or Mortality
2) Assess Bleeding Severity
3) Resuscitation:
- correct fluid loss w/ IV fluids
4) Indications for Blood Transfusion
- give if blood loss b/w 1.5-2 L
- Hgb <7 mg/dL
5) Place NG tube
6) Correct any Coagulopathy
7) Ask Q's about pts PMH
8) Endoscopy
9) Pharmacological Tx: IV PPI (DOC), Somatostatin analogues (adjunctive tx), D/C ASA/NSAIDs/Anticoags. |
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Term
| Goal Hgb in High Risk Pts |
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Definition
| >10 mg/dL (older pts w/ comorbid conditions [CAD, liver cirrhosis]) |
|
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Term
|
Definition
| >7 mg/dL (younger pts w/ NO comorbid diseases) |
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Term
|
Definition
place tube into stomach;
suction out any aspirate;
If no aspirate:
- bleeding resolved spontaneously
OR
- bleeding beyond the pylorus |
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Term
|
Definition
do NOT delay endoscopy to do this;
Give Fresh Frozen Plasma (FFP) if INR >1.5;
Give Plts if Plt count is <50,000 |
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Term
| Questions to Ask about PMH |
|
Definition
EtOH use;
Hx of liver dx or varices;
Hx of ulcers;
Weight loss;
Dysphagia;
Heartburn;
Abdominal Aortic Aneurysm |
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Term
|
Definition
If severe bleed, perform this procedure ASAP (HR >100 bpm, SBP <100 mmHg, Hgb <10 gm/dL);
If mild-moderate bleed (BP nml, HR nml), do procedure when possible;
If large amount of bleeding suspected:
- give ERYTHROMYCIN 3 mg/kg IV over 20-30 min, give 30-90 min before procedure |
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Term
| IV PPI - pantoprazole 80 mg bolus, then 8 mg/hr x 72 hrs |
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Definition
DRUG OF CHOICE for Tx of UGIB;
- give 80 mg bolus drip, then 8 mg/hr x 72 hrs OR high dose BID;
Length of Therapy: 3 days |
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Term
|
Definition
somatostatin analog:
- adjunctive tx BEFORE EGD |
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Term
|
Definition
| indicates bleed on left side of colon |
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Term
| Dark/maroon colored stool |
|
Definition
| indicates bleed on right side of colon |
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Term
| High Risk Pts w/ LGIB Complications |
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Definition
Hemodynamic instability;
Serious comorbid conditions;
Persistent bleeding;
Need for multiple blood transfusions |
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Term
| Low Risk Pts for LGIB Complications |
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Definition
Young pt;
Bleeding resolves spontaneously |
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Term
|
Definition
1) Resuscitation: IVF &/or vasopressors;
2) Correct coagulopathy
3) Consider NG tube placement
4) Colonoscopy - **Exam of CHOICE** --> cleanse colon before procedure: GoLytely, Colyte - drink 4-6 L over 2 hrs |
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