Flashcards in EXAM #2: GI BLEEDING Deck (49)
What delineates between upper and lower GI bleeding?
What does occult bleeding indicate?
Slow bleeding/ low volume
What is melena and indication of?
What is hematochezia?
Dark red blood or dark maroon colored blood
What does hematochezia indicate?
- Usually lower GI bleed
- Potentially v. fast UGI
What do you need to remember about stool color?
DO NOT USE STOOL COLOR TO R/O ORIGIN
What is the typical manifestation of chronic GI bleeding?
What is the typical presentation of acute GI bleeding?
Signs and symptoms of volume loss
How much does the blood pressure need to drop when changing positions for positive orthostatic changes?
20 mm/Hg (systolic), also:
- 10 mm/Hg diastolic
- HR increase 10 bpm
What change will be heard with bowel sounds in a UGI?
Increased bowel sounds--blood is an irritant
Review the first case study in the ppt. How sick is the patient? Why?
- Hx of HTN and hypotensive
- Beta blocker and tachycardia
- Orthostatic changes
What is the DDx of a UGI?
2) Erosive esophagitis/ gastritis/ duodenitis i.e. NSAIDs or H. pylori
3) Gastroesophageal varices
What is GAVE?
Gastric antral vascular ectasia
- Dilated small vessels in the antrum of the stomach
What is the buzzword associated with GAVE?
What is a cause of UGI that is associated with very high mortality?
- Abnormal connection between aorta and intestines
- Typically occurs secondary to AAA repair
What is a Dieulafoy lesion?
- Abnormal arterial GI vessel
- V. superficial
- Life-threatening bleeding results
What is the most common etiology of lower GI bleed, especially in the elderly?
List the three most common causes of Lower GI Bleed.
What two diseases increase the rate of Angiectasias?
2) Renal failure
What is Osler-Weber Rendu?
Genetic disorder that causes diffuse vascular dysplasia
- Increases the risk for bleeding
- Also known as Hereditary Hemorrhagic Telangectasia (HHT)
- Autosomal dominant inheritance
What two diseases can cause hyperpigmentation of the oral mucosa that can predispose one to GI bleeding?
1) Osler-Weber Rendu/ HHT
2) Peutz-Jeghers Syndrome
What must be performed during the PE if you suspect volume loss in a patient?
Orthostatic vital signs
What are the predictors of UGI?
1) Less than 50 y/o
2) Melenic stool
3) BUN/Creatinine ratio greater than 30
What are the indications for an NG tube in the face of GI Bleeding?
2) Frank hematochezia
Note that 15-20% of patients with upper GI bleeding will have a negative NG aspirate--keep in differential even if negative.
How do you begin the resuscitation of a patient with significant hypovolemia?
1) IV access (bilateral large bore)
3) Anticipate need for blood transfusion
When do you need to transfuse a patient with a GI bleed?
Hgb less than or equal to 7 g/dL
What is AIMS65? What is it used for?
Risk score that predicts mortality, length of stay, and cost
- Albumin less than 3
- INR greater than 1.5
- Systolic less than 90 mm/Hg
- 65+ y/o
What is the Rockall Scoring System?
Predictor of mortality in UGIB
What is the utility of the Blatchford Score?
This score predicts the NEED for ENDOSCOPIC THERAPY