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957 Block 2 > 5. Upper GI Bleeding > Flashcards

5. Upper GI Bleeding Flashcards

1
Q

What are the 2 types of UGIB?

A
  • Variceal

- Non-variceal

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2
Q

What are the subtypes of non-variceal UGIB?

A
  • peptic ulcer disease
  • stress related mucosal disease
  • Mallory-Weiss tear
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3
Q

What are the common causes of PUD?

A

NSAID use

H. pylori infection

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4
Q

What are common causes of variceal UGIB?

A
  • cirrhosis

- portal HTN

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5
Q

What landmark defines an upper GI source?

A

above the ligament of Treitz

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6
Q

What are some distinguishing symptoms of UGIB?

A
  • hematemesis
  • melena
  • hematochezia
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7
Q

What is hematemesis?

A
  • vomiting blood

- can look like coffee grounds

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8
Q

What is melena?

A

dark, digested blood in stool (tar-like)

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9
Q

What is hematochezia?

A

BRBPR

bright red blood per rectum

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10
Q

What is the mainstay therapy for UGIB?

A

endoscopy

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11
Q

NSAID induced gastropathy is due to inhibition of what?

A

COX-1

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12
Q

What are risk factors for continued bleeding/ recurrence?

A

Clinical: age (>65), shock, comorbidities, low Hgb, melena
Lab: ↓SBP, ↓Hgb, ↑ BUN, ↑ liver enzymes

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13
Q

Describe an ulcer that is unlikely to re-bleed?

A
  • clean based ulcer

- non-protuberant pigmented clot

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14
Q

What ulcer characteristics require intervention?

A
  • adherent clot
  • non-bleeding visible vessel
  • active bleeding
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15
Q

What is the guideline recommendation for PPI therapy?

A

Pantoprazole 80 mg bolus + 8 mg/hr for 72 hrs

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16
Q

In a UGIB, you only treat H.pylori if there are systemic symptoms. (T/F)

A

False: treat H.pylori if present

17
Q

How is H.pylori treated?

A

PPI

antibiotics

18
Q

Increasing gastric pH helps do what?

A
  • promote platelet aggregation
  • strengthen clot formation
  • inhibit fibrinolysis
19
Q

Esophageal varices are present in ___% of patients with cirrhosis.

A

50

20
Q

Why do esophageal varices occur?

A

portal HTN and the development of collateral bloodflow

21
Q

Varicies only arise in the esophagus. (T/F)

A

False: can develop anywhere in the GI tract

22
Q

Where are the most common locations for varices?

A

esophagus
stomach
rectum

23
Q

Gastroesophageal junction has the thinnest tissue layer of GI tract. (T/F)

A

True

24
Q

What is the gold standard for diagnosis of variceal bleeding?

A

esophagogastroduodenoscopy (EGD)

25
Q

When should treatment for suspected variceal bleed occur?

A

immediately

26
Q

How do somatostatin analogs treat variceal bleeding?

A

cause splanchnic vasoconstriction : reduces blood inflow

27
Q

What is the somatostatin regimen for variceal bleeding?

A

Octreotide 50 mcg bolus + 25-50 mcg/hr x 2-5 days

28
Q

What is the PPI regimen for variceal bleeding?

A

none: not generally effective in variceal bleeding

29
Q

You should hold beta blocker therapy in a patient with a variceal bleed. (T/F)

A

true

30
Q

Endoscopies should be performed within __ hours of bleed.

A

12

31
Q

What are some treatment options that are conducted via endoscope?

A
  • sclerotherapy
  • banding
  • clipping
32
Q

What is the TIPS procedure?

A

A shunting surgery that helps blood flow through the hepatic vasculature.

33
Q

Balloon tamponade is used as a ________ to the TIPS procedure.

a. alternative
b. bridge
c. preparation
d. reversal

A

bridge

34
Q

In addition to somatostatin therapy, what other therapy should be included in a cirrhotic variceal bleed?

A

antibiotics

35
Q

Why are cirrhotic patients at risk for infection?

A

Low albumin (from liver damage) allows fluid to leak out of vasculature. This fluid tends to accumulate in the peritoneal cavity and is an excellent growth medium for bacteria.

36
Q

What antibiotics are used in variceal bleeding?

A

Norfloxacin

Ceftriaxone

957 Block 2 (14 decks)

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