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