Bleeding Disorders
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| What divides the Upper and Lower GI tract? | Ligament of Treitz
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| Farthest you can usually go with colonoscopy | Cecum.
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| coffee ground emesis | old blood from stomach
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| 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
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| Medications associated with GI bleed | NSAIDs (even 81mg ASA, Goodies, BC powders), steroids in the setting of NSAIDs, Warfarin, Heparin, enoxaprin, plavix
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| Resting Tachycardia indicates | 10% of intravascular volume lost
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| Orthostasis indicates | significant loss, 10-20% of intravascular volume
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| Loss of 20-40% of intravascular volume | SHOCK
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| What can cause a positive guaiac test? | hemorrhoids, fissures
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| 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
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| Labs | Hgb, BUN, Liver tests
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| watermelon Stomach | gastric antral vascular ectasia (GAVE); small ectatic vessels in the antrum of the stomach. most commonly in cirrhotic pts
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| BUN can ________ in the setting of GI bleeding | increase disproportionately to Creatinine. From breakdown of blood to urea with digestions.
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| 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.
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| What should you do if you suspect a variceal bleed? | NG lavage
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| Esophageal and Gastric Varices | secondary to portal htn, massive upper GI bleeds with hemodynamic instability
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| 3 most common causes of upper GI bleeds | Peptic ulcer dz (55%), Varices (14%), atriovenous malformation (6%)
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| 3 most common causes of lower GI bleeds | Diverticular dz (33%), Neoplastic Dz (polyps, cancer; 19%), Colitis (18%)
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| 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
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| ______ can help to delineate upper from lower source | NG lavage. Bloody aspirate helps confirm upper bleed
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| Negative NG lavage | bilious return signifying that fluid aspirated from duodenum
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| NG lavage may miss _____ bleeds | UGI bleeds: negative in 25% of upper GI bleeds
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| Diagnostic Testing/Therapeutic interventions | Endoscopy (EGD, Enteroscopy, Colonoscopy), Radionuclide Imaging (tRBC), Angiography
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| _______ has both diagnostic and therapeutic potential | Endoscopy
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| Ulcer therapy | PPI, Eradication of H. pylori if present, Endoscopic therapy, Angiogram or surgery if endoscopy fails
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| Arterial lesion that occurs in the stomach | Dieulafoy's lesion. bleeds like stink
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| Tears in the GE junction that usually occur after retching | Mallor-Weiss Tear. 80-90% stop bleeding spontaneously. Usually supportive care
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| colonoscopy in setting of acute bleed | not helpful
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| purpose of tagged rbc scan | localize the bleed. great for slow bleeds. Safe, noninvasive, no therapeutic capability. Positive scan followed by interventional angiography
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| 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
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| Melena can come from | upper and lower slow GI bleeds
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| Bright red blood can come from | upper and lower rapid GI bleeds
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| Hematocrit measurements in GI bleeds | can take up to 2 days for hematocrit to reflect extent of bleeding
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| Upper GI bleed tx | 80% of UGIBs are self-limited and require only supportive care.
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| Who should receive blood transfusion? | Unstable pts (hypotensive, tachycardia), pts with active bleeding, low hemoglobin (pt dependent)
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| Acute, painless hematochezia that usually stops spontaneously | Diverticular bleeding
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