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Flashcards in GI Bleeding Deck (35)
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1

Define Upper GI Bleed

Bleed from a source above the Ligament of Trietz

2

Define Lower GI Bleed

Bleed from a source below the Ligament of Trietz

3

Presentation of Upper GI Bleeding

Hematemesis
Blood/coffee grounds detected during nasogastric lavage
Melena
BUN to creatinine ratio >30

4

Presentation of Lower GI Bleeding

Blood clots in stool
Red blood mixed with solid brown stool
Dripping of blood into the toilet after a bowel movement

5

Define Hematemesis

Red or brown flakes like coffee grounds

6

What is the minimum amount of blood to be considered melon?

50-100 mL

7

Define Hematochezia

Red or maroon colored stool
Usually lower GI

8

What causes coffee-ground emesis?

Blood sitting in the stomach acid causes the iron to oxidize resulting in the appearance of coffee ground like flakes

9

Features of an Upper GI Bleed

More significant bleeding
Above the LoT
Presentation: hematemesis, melena, hematochezia
Nasogastric lavage: blood
Hyperactive bowel sounds
BUN:Creat >30:1

10

Features of a Lower GI Bleed

Less likely shock or require transfusion
Below the LoT
Presentation: Hematochezia
Nasogastric lavage: Clear fluid
Normal bowel sounds
Normal BUN:Creat

11

What Produces Ammonia?

Burns
Tetracycline
Steroids
Fever
Catabolic state
Upper GI bleeding

12

Etiologies of Upper GI Bleeds

PUD
Portal HTN
Mallord-Weiss tears
Vascular anomalies
Erosive gastritis
Erosive esophagitis
Gastric neoplasm
Aortoenteric fistula
Hepatic tumor
Angioma
Penetrating trauma
Pancreatic malignancy

13

What results because of portal HTN?

Esophageal, gastric, and duodenal varies that can rupture

14

Most Common Cause of Portal HTN

Cirrhosis

15

Etiologies of Mallory-Weiss Tears

Retching
Seizure
Childbirth
Coughing
Straining
Defecation
Weight lifting

16

Define Angiodysplasia

Small AV malformations

17

What is telangectasis associated with?

CREST syndrome
HHT: hereditary hemorrhagic telangiectasia

18

What is erosive esophagitis secondary to?

Chronic reflux

19

Etiology of Lower GI Bleeding in Patients

Infectious colitis
Anorectal disease
IBD

20

Etiology of Lower GI Bleeding in Patients >50

Diverticulosis
Agioectasias
Malignancy
Ischemia
Radiation induced proctitis
Acute infectious colitis

21

Define Diverticulosis

Acute, painless, large volume maroon or bright red hematochezia

22

Define Angioectasias

Painless bleeding in the upper or lower GI tract

23

Main Anorectal Disease in Lower GI Bleeding

Hemorrhoids
Fissures

24

When do you usually see ischemic colitis?

Older patients with atherosclerotic disease
Young patients with long distance running

25

Initial Management of GI Bleeding

Stabilization
Blood replacement
GI consult for upper/lower endoscopy

26

Severe Bleeding SBP & HR

SBP: 100

27

Moderate Bleeding SBP & HR

SBP: >100 mmHg
HR >100

28

Minor Bleeding SBP & HR

Normal HR & BP

29

Labs in Assessing GI Bleeding

CBC
PT/INR
CMP
Type/screen

30

Stabilization of a GI Bleed Patient

2 large bore IV's
NS or LR
Nasogastric tube +/-
IV PPI for upper GI
IV octreotide or somatostatin for portal HTN