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CM GI Bleeding Disor

Bleeding Disorders

QuestionAnswer
What divides the Upper and Lower GI tract? Ligament of Treitz
Farthest you can usually go with colonoscopy Cecum.
coffee ground emesis old blood from stomach
Black, sticky, tarry is melena. Also has a foul, unforgettable smell. Usually means that blood has been in the GI tract for about 12-14 hours
Medications associated with GI bleed NSAIDs (even 81mg ASA, Goodies, BC powders), steroids in the setting of NSAIDs, Warfarin, Heparin, enoxaprin, plavix
Resting Tachycardia indicates 10% of intravascular volume lost
Orthostasis indicates significant loss, 10-20% of intravascular volume
Loss of 20-40% of intravascular volume SHOCK
What can cause a positive guaiac test? hemorrhoids, fissures
Stool guaiac should only be used for colon cancer screening and should not be used to test of active bleeding b/c the process itself can be traumatic enough to cause false positive
Labs Hgb, BUN, Liver tests
watermelon Stomach gastric antral vascular ectasia (GAVE); small ectatic vessels in the antrum of the stomach. most commonly in cirrhotic pts
BUN can ________ in the setting of GI bleeding increase disproportionately to Creatinine. From breakdown of blood to urea with digestions.
Things that turn your stool black iron, anything with bismuth (pepto, maalox), beets. Iron and bismuth stools are fairly firm and they don't smell awful.
What should you do if you suspect a variceal bleed? NG lavage
Esophageal and Gastric Varices secondary to portal htn, massive upper GI bleeds with hemodynamic instability
3 most common causes of upper GI bleeds Peptic ulcer dz (55%), Varices (14%), atriovenous malformation (6%)
3 most common causes of lower GI bleeds Diverticular dz (33%), Neoplastic Dz (polyps, cancer; 19%), Colitis (18%)
GI bleeding management Normal Vitals: IV fluid through two large bore IV lines (16-18 gauge), type and screen immediately (O- if things get crazy), DC anticoagulants and antiplatelets, PPI drips,determine source
______ can help to delineate upper from lower source NG lavage. Bloody aspirate helps confirm upper bleed
Negative NG lavage bilious return signifying that fluid aspirated from duodenum
NG lavage may miss _____ bleeds UGI bleeds: negative in 25% of upper GI bleeds
Diagnostic Testing/Therapeutic interventions Endoscopy (EGD, Enteroscopy, Colonoscopy), Radionuclide Imaging (tRBC), Angiography
_______ has both diagnostic and therapeutic potential Endoscopy
Ulcer therapy PPI, Eradication of H. pylori if present, Endoscopic therapy, Angiogram or surgery if endoscopy fails
Arterial lesion that occurs in the stomach Dieulafoy's lesion. bleeds like stink
Tears in the GE junction that usually occur after retching Mallor-Weiss Tear. 80-90% stop bleeding spontaneously. Usually supportive care
colonoscopy in setting of acute bleed not helpful
purpose of tagged rbc scan localize the bleed. great for slow bleeds. Safe, noninvasive, no therapeutic capability. Positive scan followed by interventional angiography
Approach to Acute GI bleeding in all patients: ABC's, vital signs, orthostatics, hx and physical (comorbidities, meds, prior scopes), NG lavage, Rectal exam, Labs: Hgb, platelets, INR, BUN, Cr
Melena can come from upper and lower slow GI bleeds
Bright red blood can come from upper and lower rapid GI bleeds
Hematocrit measurements in GI bleeds can take up to 2 days for hematocrit to reflect extent of bleeding
Upper GI bleed tx 80% of UGIBs are self-limited and require only supportive care.
Who should receive blood transfusion? Unstable pts (hypotensive, tachycardia), pts with active bleeding, low hemoglobin (pt dependent)
Acute, painless hematochezia that usually stops spontaneously Diverticular bleeding
Created by: ltm12
 

 



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