14: GIBs Flashcards
(22 cards)
When do you give O negative blood for a bleed?
When pt is too unstable with ongoing bleeding -> cant wait for cross matched blood
What does ringer’s lactate have in it that normal saline does not? (3 things)
- Potassium
- A little lactate
- A little calcium
Which is more likely to cause hemodynamic instability and why? UBIG or LGIB
UGIB - rich blood supply of upper GI tract
What % of the time is melena due to LGIB**
10%
BRBPR vs maroon blood hematochezia
BRB: left colon
Maroon: right colon or small bowel
how to differentiate lower vs upper GI + where that thing is in the GI tract
Ligament of Treitz - between duodenum and jejunum
Three types of meds/ingestables that you need to ask about during GIB sx that are considered “masqueraders” + why
- Beta blockers: wont show hypovolemic shock sx
- Meds with Fe or bismuth: dark stools
- Liquid meds with red dye or foods like beets/koolaid - look like hematochezia
What will hemoccult results be if pt is on a med with Fe or bismuth?
Positive
Packed RBCs (PRBCs): function
Most common transfused blood product, given to increase oxygen carrying capacity of blood
A single unit of PRBC will raise Hb and Hct how much?
Hb: 1g/dL
Hct: 3%
FFP: other name
Fresh frozen plasma; cryoprecipitate
FFP: function
Contains all coagulation factors - used to reverse warfarin with life threatening bleeding
Platelet transfusion: when is it indicated?
Pts with active acute GIB + platelet count <50,000
6 units of platelets increases platelet count how much?
50,000 per cubic mm
Three ranges of Hb and whether or not transfusion is recommended
- Hb <7: recommended in any case
- Hb 8-10: not indicated unless symptomatic, ongoing bleeding, or precipitation of underlying comorbidities
- Hb >10: not indicated except in exceptional circumstances
What type of solutions are NS and lactated ringers?
Isotonic crystalloid solutions
Why is endoscopy the gold standard for GIBs?
Diagnoses and can treat the source of bleeding
Three methods of endoscopic hemostasis
- Injection: vasoconstrictors, saline, adhesives
- Thermal therapy: cauterized vessels
- Mechanical therapy: hemoclips or rubber glands to close vessels
What does TIPS stand for?
Trans-jugular intrahepatic Portosystemic shunt
How does TIPS procedure work?
Creates a low-resistance channel between hepatic vein + intrahepatic portion of portal vein -> decreases portal HTN to prevent varices
Colonoscopy for diverticular bleed
Can try to localize a particular bleeding vessel and treat it, but is sometimes difficult to ID bc of how many diverticuli + there may be multiple bleeding at once
Most common cause of slow occult LGIB
Colon carcinoma
