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DU PA GI bleed

Duke PA GI bleed

upper bleeds are above the ligament of treitz
upper bleeds are __X more common than lower bleeds 5
lower bleeds are below the ligament of treitz
sign of upper GI Bleed hematemesis
coffee ground emesis old blood from stomach
red blood with or without stool, BRBPR hematochezia
dark tarry stools melena
color of melena black, and nothing else
black, sticky, tarry, foul, unforgettable smell melena
__ml of blood can give you melena 50
melena usually means that the blood has been in the GI tract for __ 12-14 hours
medications associated with GI bleed NSAIDS, ASA, steroids with NSAIDS, Warfarin, Heparin, enoxaparin, clopidogrel
__ means that 10% of intravascular volume is lost resting tachycardia
__means that there has been a significant loss (10-20%) of intravascular volume orthostasis
__ means that there has been a loss of 20-40% of intravascular volume shock
brown stool on rectal exam means __ not an acute bleed
it can take up to __ for hematocrit to reflect extent of bleeding 2 days
things that turn your stool black other than blood iron, anything with bismuth (pepto, Maalox)
mortality rate of upper GI bleed 8-10%
most common causes of upper GI bleed peptic ulcer disease, varices, arteriovenous malformation
most common causes of lower GI bleed diverticular disease, neoplastic disease, colitis (infectious, radiation, ischemic, IBD)
anemia with brown stool (guaiac +), iron deficiency anemia chronic GI blood loss
the mainstay of initial treatment for acute GI bleed resuscitation through large bore IV, with the goal being normal vitals
patients who should be transfused unstable patients (hypotensive, tachycardia), active bleeders, low hemoglobin (Hct >30%, Hgb 10)
medical therapy for variceal bleeds octreotide drip, antibiotics, discontinue all anticoags/antiplatelets
medical therapy for suspected upper bleed from peptic ulcer proton pump inhibitor (pantoprazole drip if severe), discontinue all anticoags/antiplatelets
can help to delineate upper from lower source, bloody aspirate helps confirm upper bleed nasogastric lavage
bloody NG lavage with hematochezia brisk upper GI bleed
"negative NG lavage" bilious return signifying that fluid aspirated from duodenum
laceration in the mucosa, usually near the GE junction commonly after retching, 80-90% stop bleeding spontaneously Mallory-Weiss tear
dilated submucosal artery erodes into the mucosa with subsequent rupture of the vessel, bleeding often massive and recurrent Dieulafoy's lesion
acute, painless hematochezia, usually stops spontaneously, risk of rebleed appears to increase with time diverticular bleeding
can help localize bleeding, detects bleeding as small as 0.1-0.5 ml/min, safe, non-invasive, no therapeutic capability tagged RBC scan
Created by: bwyche