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Gastrointestinal > GI bleeds > Flashcards

GI bleeds Flashcards

1
Q

What are the parts of the upper GI system?

A

Duodenum and up

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2
Q

What are lower GI bleeds?

A

Jejunum down

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3
Q

What does a positive guaiac indicate?

A

Usually slow bleeding, but does not help to localize

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4
Q

What does melena indicate?

A

Upper GI bleed

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5
Q

What does hematochezia indicate?

A

Colonic origin of the blood

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6
Q

Chronic GI blood loss will usually present concurrently with what? Acute?

A 
Acute = hypotensive
Chronic = Anemia
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7
Q

Large blood volume loss in a patient with preexisting CAD may indicate what?

A

Ischemic bowel

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8
Q

What is the qualification for diagnosing orthostatic hypotension?

A

20 mmHg fall upon standing

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9
Q

What happens to BS with GI bleeding?

A

Increased due to irritation

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10
Q

What is in the ddx for an upper GI bleed?

A

PUD
Erosive esophagitis
Gastroesophageal varices

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11
Q

Painful hematemesis = ?

Painless hematemesis = ?

A

Painful = mallory weiss tear

Painless = esophageal varices

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12
Q

What is a Dieulafoy’s lesion?

A

A medical condition characterized by a large tortuous arteriole in the stomach wall (submucosal) that erodes and bleeds. It can cause gastric hemorrhage but is relatively uncommon

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13
Q

What are the three ways to differentiate salmonella from shigella?

A

Salmonella has:

  1. Glucose fermentation
  2. H2S production
  3. Motile
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14
Q

What type of motility does listeria have?

A

Tumbling

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15
Q

What is the genetic cause of Peutz-Jeghers disease? ssx?

A

STK11 mutation

maculas over the oral mucosa, and predisposition to a variety of CAs

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16
Q

What is Osler-Weber Rendu syndrome?

A

an autosomal dominant genetic disorder that leads to abnormal blood vessel formation in the skin, mucous membranes, and often in organs such as the lungs, liver, and brain.

Presents with telangiectasia on the oral mucosa

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17
Q

If the BUN/creatinine ratio is greater than what value, what is this indicative of? Why is this?

A

> 30 then think upper GI bleed

Reabsorption of Hb proteins causes nitrogen metabolism

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18
Q

When is an NG tube indicated for an upper GI bleed? Why?

A

Severe hematochezia

BRB per NG tube is predictive, but not indicative of endoscopic lesion. (15-20% of patients with an upper GI bleed will not have blood on NG tube sample)

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19
Q

What type of IV do you want for resuscitating pts with acute GI bleeds?

A

Large bore peripheral IV access

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20
Q

When should resuscitation measures be undertaken with acute GI bleeds?

A

Tissue hypoxia

Hb

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21
Q

What is the first type of drug used for resuscitation for acute GI bleeds?

A

Crystalloids

22
Q

1 unit of pRBC raises Hb by how much?

A

1

23
Q

What is the Blatchford score used for?

A

Discriminating low risk UGIB pts who will likely NOT require endoscopic hemostasis

24
Q

What is the first drug that is used for non-variceal UGIB? Why?

A

PPIs

Suppress acid, facilitates clot formation and stabilization

25
Q

How soon should pts with non-variceal UGIB have an endoscopy?

A

within 24 hours

26
Q

What percent of GI bleeds spontaneously resolve?

A

80%

27
Q

What is the continued/rebleeding rate of active bleeds?

A

55-90%

28
Q

What is the continued/rebleeding rate of non-bleeding visible vessel?

A

40-50%

29
Q

What are the three procedures that endoscopic hemostasis therapy can do?

A

Epi injection
Thermal electrocoag
Hemoclips

30
Q

When should pts with GI bleeds with concurrent CAD, when should they resume ASA therapy?

A

As soon as bleeding has resolved

31
Q

What are the three predictors of large esophageal varices?

A
  1. Severity of liver disease
  2. Platelet count
  3. Palpable spleen
32
Q

What are the components of variceal bleed management?

A 
Vasoconstriction
Abx
Resuscitation
ICU
Endoscopy
Alterna rescue therapy
Beta blockers
33
Q

What is the most common vasoconstrictor for GI bleeds?

A

Octreotide

34
Q

What are the abx used for GI bleeds?

A

Ceftriaxone

35
Q

What is the complication with fast transfusions in pts with variceal bleeds?

A

May increase portal HTN

36
Q

What is the use of beta blockers in GI bleeds? What type should be used?

A

Reduced the risk for recurrent variceal hemorrhage

non-selective (1st generation)

37
Q

What is the most common cause of lower GI bleeds?

A

Diverticulosis

38
Q

What drug is associated with lower GI bleeds?

A

ASA

39
Q

What are the three major risk factors for mortality in lower GI bleeds?

A

Age
Intestinal ischemia
Comorbid illnesses

40
Q

What is the role of colonoscopy in lower GI bleeds?

A

Do one after bleeding has stopped to located the source/etiology

41
Q

What is the major benefit of radiographic studies for GI bleeds?

A

Can see brisk bleeding

Radiologist can fix

42
Q

What is the role of surgery in GI bleeds?

A

Life threatening conditions

giving more than 6 units of pRBCs

43
Q

Which is more common upper or lower GI bleeds?

A

Upper

44
Q

What is the most common cause of GI bleeds in general?

A

PUD

45
Q

What is a gastric Antral Vascular Ectasia?

A

Dilated blood vessel in the antrum of the stomach can rupture and bleed.

46
Q

Watermelon stomach = ?

A

Gastric Antral Vascular ectasia

47
Q

Why are pts with aortic valvular disease or chronic renal failure more susceptible to GI bleeds?

A

increased incidence of capillary formations

48
Q

What is the heart rate for 45% blood loss?

A

100
30-40% = >120
>40% = >140

49
Q

What are the relative SBP changes that occur with each stage of blood loss?

A

40% = very low

50
Q

What is the Hb level at which pts with GI bleeds should be transfused?

A
51
Q

One unit of pRBCs raises HCT by what amount?

A

3%

Gastrointestinal (42 decks)

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