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DU PA GI bleed
Duke PA GI bleed
| Question | Answer |
|---|---|
| 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
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