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GI Bleeding


What is the most common cause of lower GI bleeding Hemorrhoids
Common, painless and can be massive, caused from an erosion into penetrating artery from the diverticulum Diverticulosis
What is the most common cause of upper GI bleed Peptic ulcer disease
Cause of esophageal and gastric varices Portal hypertension
Longitudinal mucosal tear in the cardioesophageal region, caused by repeated retching Mallory-Weiss syndrome
Common cause of lower GI bleeding, seen in people with hypertension and aortic stenosis Arteriovenous malformations
Spider angiomata, palmer erythema, jaundice, and gynecomastia are seen in __ Liver disease
Petechiae and purpura seen in __ Coagulopathy
Why would you do a careful ENT exam on a patient suspected of GI bleed Rule out causes that can mimic GI bleed such as epistaxis
Can be diagnostic and therapeutic but requires a brisk bleed at .5-2ml/min angiography
Can only be diagnostic but are more sensitive than angiography and require a bleeding rate of only .1ml/min bleeding scans
Is diagnostic and therapeutic and more accurate than bleeding scans and angiography Colonoscopy
For Class __ bleed: replace volume with crystalloid I and II
For Class __ bleed: replace volume with crystalloid and blood III and IV
Hemorrhaging is broken down into how many categories by the ACS 4
Class __ hemorrhage involves up to 15% of blood volume. There is typically no change in vital signs and fluid resuscitation is not usually necessary I
Class _ hemorrhage involves 15-30% of total blood volume. A patient is often tachy, narrowed pulse pressure. Peripheral vasoconstriction, pale cool skin, slight changes in behavior, volume resuscitation with crystalloids II
Class __ hemorrhage involves loss of 30-40% of blood volume; pt’s BP drops, HR increases, peripheral perfusion decreases (prolonged cap refill), mental status worsens; crystalloid & blood transfusions usually necessary III
Class __ hemorrhage involves loss of >40% of blood volume; limit of body’s compensation is reached and aggressive resuscitation is required to prevent death IV
__ ulcers do not extend through the muscularis mucosa Stress
Only __ % of patients who are infected with H. pylori will develop ulcers 10-20
Inhibits bicarbonate ion production and increases gastric emptying Cigarette smoking
Main complaint of gastric ulcer Gnawing, aching or burning epigastric pain
Physical exam of uncomplicated PUD, there may be a finding of __ Epigastric tenderness
Inhibit gastric acid secretion, equally as effective as antacids with better compliance due to decreased frequency of doses H2 antagonists
Inhibits gastric acid secretions, heals ulcers faster than H2-antagonists and antacids PPI
Locally binds to the base of the ulcer and therefore protects it from acid Sucralfate
Prostaglandin E1 analogue which acts as natural prostaglandin in the body Misoprostol
Vomiting and diarrhea is most often __ Gastroenteritis
Which is more common: upper or lower GI bleeding? upper
What is the most common cause of acute lower GI bleeding? hemorrhoids, followed by diverticular disease (most common cause of Acute GIB)
what is the most important lab test for a patient with a significant GI bleed type and crossmatch
when is surgical treatment for hemorrhoids indicated severe, intractable pain, continued bleeding, incarceration, or strangulation
treatment of choice for patients with pseudomembranous colitis metronidazole for mild to moderate disease in patients who do not respond to supportive measures
__ should be reserved for patients with pseudomembranous colitis who have not responded to or are intolerant of metronidazole and for children and pregnant patients vancomycin
for patients with pseudomembranous colitis __ may prolong or worsen symptoms and should be avoided antidiarrheal agents
Meckler triad Sx of esophageal perf: vomiting, chest pain, subQ emphysema
Upper vs lower GI bleed: anatomy ligament of Treitz
Meds assoc w/GI bleed NSAIDs; Steroids (in setting of NSAID); Warfarin; Heparin, Enoxaparin; Clopidogrel (Plavix)
3 most common causes of upper GI bleed PUD (55%); Varices (14%); AVM (6%)
3 most common causes of lower GI bleed Diverticular Dz (33%); Neoplastic Dz (Polyps, Ca; 19%); Colitis (18%)
Resting Tachycardia: blood loss = 10% of intravascular volume lost
Orthostasis: blood loss = Significant loss, 10-20% of intravascular volume
Shock: blood loss = Loss of 20-40% of intravascular volume
Chronic GI blood loss: defined by: Fe def anemia: Low Ferritin (<30); Low Fe, High TIBC; Low MCV; also Anemia w/brown stool (Guaiac pos)
GI bleed: mainstay of initial tx Resuscitation; goal = normal vital sx; 2 lg bore IVs; ICU monitoring if needed
Dieulafoy’s Lesion = Dilated submucosal artery erodes into mucosa with subsequent rupture of the vessel; bleeding often massive & recurrent
Mallory-Weiss tear: Laceration in the mucosa, usually near GE junction; commonly after retching
Diagnostic tools for LGIB Anoscopy; Flexible Sigmoidoscopy; Colonoscopy; Tagged red blood cell scan; Angiography
Diverticular bleeding: sxs and location Acute, painless hematochezia; most bleeds are right sided
Role of tagged scan help localize bleeding; pre-test for angiography; detects bleeding (0.1 to 0.5 mL/min; less sensitive w/inc bowel motility); no tx capability
LGIB: Angiography: caution: Caution w/renal failure given IV contrast load
LGIB: Angiography: utility Coil microembolization of bleeding vessel; blood flow must be 1 mL/min
Diverticular disease etiology Herniations of colonic mucosa thru muscularis (typically at site of least resistance), often where nutrient artery penetrates muscularis; mostly in sigmoid (1/3 in proximal colon)
Contraindicated during acute diverticulitis: colonoscopy / sigmoidoscopy
Diverticular disease imaging: Xray (free abd air); CT (to dx abscess / inflammation); scopy to r/o or confirm dx; hemorrhage: 99mTc-labeled RBC scan, mesenteric angiogram, scintigraphy
Diverticular disease tx: mild: PO Flagyl + (Cipro or SMX-TMP); hospitalize if no response to tx -> IV Abx
Causes of upper GI bleed PUD, MW tear, AVM, esophageal varices
Meds assoc w/GI bleed NSAIDs; Steroids (in setting of NSAID); Warfarin; Heparin, Enoxaparin; Clopidogrel (Plavix
3 most common causes of upper GI bleed PUD (55%); Varices (14%); AVM (6%)
3 most common causes of lower GI bleed Diverticular Dz (33%); Neoplastic Dz (Polyps, Ca; 19%); Colitis (18%)
Dieulafoy Lesion = Dilated submucosal artery erodes into mucosa with subsequent rupture of the vessel; bleeding often massive & recurrent
Diverticular bleeding = Acute, painless hematochezia; most bleeds are right sided
Definition and MOA of diverticulosis herniation of mucosa through the muscular wall of the intestine
Most common cause of massive lower GI bleed in elderly: diverticular bleeding
Orthostasis (SBP drops >10 and HR increases by 10 w/change in position) equates to what volume of blood loss in GIB? 800 mL
GI bleed diagnostic algorithm Stabilize VS (eg, fluid resuscitation, 20 ga IV x2); determine upper vs lower; scope +/- NGT for blood; ID source and tx
If EGD & colonoscopy are neg, consider: small bowel studies (eg, VCE, SBFT)
If LGIB too brisk to allow colonoscopy, do: 99mTc-labeled RBC scan, scintigraphy
Common cause of obscure bleeding (eg, in small bowel): vascular ectasias (flat lesion, hard to visualize)
Created by: Abarnard
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