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GI BLEED Flashcards

1
Q

what is the definition of a GI bleed?

A

bleeding of any degree from anywhere along the GI tract that indicates underlying pathology

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2
Q

what are the 2 divisions of GI bleeds?

A
  1. upper
  2. lower
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3
Q

what is an upper GI bleed?

A

hemorrhage proximal to the ligament of Treitz
70% OF BLEEDS

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4
Q

what is a lower GI bleed?

A

hemorrhage distal to the ligament of Treitz
30% of bleeds

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5
Q

what are the GI bleeds classified into?

A
  1. acute (<3 days) or chronic (>3days) bleeding
  2. overt or occult bleeding
    -overt: visible bleeding
    -occult: only detectable by chemical testing of a
    stool specimen
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6
Q

what are the 8 risk factors of GI bleeds?

A
  1. hx of GI bleed
  2. H. Pylori
  3. NSAIDs
  4. anticoag use
  5. alcohol use
  6. cirrhosis
  7. vascular disease
  8. older age
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7
Q

what is PGE2?

A

it provides gastroprotection by increasing mucus secretion and inhibiting gastric acid secretion

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8
Q

what inhibits the production of prostagandins (PGs) through the inhibition of COX-1 and COX-2?

A

NSAIDs

basically they knock out PGE2

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9
Q

what is the #1 cause of an upper GI bleed?

A

peptic ulcer disease (PUD)
- gastric ulcer
- duodenal ulcer

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10
Q

what is the #1 cause of a lower GI bleed?

A

diverticular disease
- diverticulosis
- diverticulitis

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11
Q

what are the other causes of an upper GI bleed?

A
  1. erosive -gastritis, esophagitis
  2. esophageal or gastric varices
  3. esophageal cancer
  4. mallory weiss tears
  5. boerhaaves
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12
Q

what are the other causes of a lower GI bleed?

A
  1. hemorrhoids
  2. infectious colitis
  3. anal fissures
  4. IBD
    -crohn’s, ucerative colitis
  5. colorectal cancer
  6. iatrogenic- after biopsy or radiation
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13
Q

what are the s/s of a GI bleed in patients with occult bleeding?

A

asymptomatic

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14
Q

what are the s/s of anemia related to a GI bleed?

A
  1. fatigue/weakness
  2. dyspnea
  3. pallor
  4. lightheaded
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15
Q

what are the s/s of a GI bleed that is not occult or anemia related?

A
  1. heartburn
  2. abdominal pain
  3. weight loss…. should make you think malignancy
  4. hematemesis
  5. hematochezia
  6. melena
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16
Q

what does hematemesis indicate?

A

upper GI bleed

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17
Q

what is hematemesis?

A

vomiting of red blood or “coffee ground” material

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18
Q

what is coffee ground emesis and what is its patho?

A

vomit that is dark brown resembling coffee
- d/t conversion of red Hgb in brown hematin by
gastric acid

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19
Q

what does hematochezia indicate?

A

lower GI bleed (more often) or vigorous upper GI bleed w/ rapid transit through intestines

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20
Q

what is hematochezia?

A

passage of gross blood from rectum

bright red blood

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21
Q

what does melena indicate?

A

upper GI bleed usually, but can occur w/ small intestine or proximal colonic bleed

22
Q

what is melena?

A

black tarry stool

23
Q

what can black stool that does not contain occult blood be d/t?

A

ingestion of iron, bismuth (pepto bismal), or various foods

24
Q

what is the definition of hemodynamic instabililty?

A

occurs when there is a decrease in BP leading to lowered blood flow to the body’s organs

25
Q

what are primary hemodynamic parameters?

A

HR, and BP

26
Q

what are advanced hemodynamic parameters?

A

SV, CO, TPR

27
Q

what is characterized as mild hypovolemia?

A

<15% blood vol loss w/ resting tachycardia

28
Q

what is characterized as moderate hypovolemia?

A

15-40% blood vol loss w/ orthostatic hypotension

29
Q

what is characterized as severe hypovolemia?

A

> 40% blood vol. loss w/ hypotension

30
Q

what are indicators of shock or hypovolemia?

A

tachycardia, tachypnea, pallor, diaphoresis, confusion, oliguria

31
Q

why would a patient with a GI bleed present with oliguria?

A

d/t less perfusion to the kidneys to be filtered

32
Q

what are some external stigmata of bleeding disorders that can be seen in patients with GI bleeds?

A

petechiae or ecchymosis

33
Q

what are signs of chronic liver disease that can be seen in a patient with a GI bleed?

A

spider angiomas, ascites, palmar erythema, dilated abdominal wall veins, splenomegaly

34
Q

what are you looking for on digital rectal exam?

A

stool color, masses or fissures, stool specimen for occult blood

35
Q

do you want vital signs including orthostatic measurements when doing PE for GI bleed?

A

duh

36
Q

what are some meds that can increase risk of bleeding?

A

NSAIDs, aspirin, clopidogrel, anticoags, SSRI’s

37
Q

what is hematemesis in regards to distinguishing it from hemoptysis?

A

blood passed w/ initial vomiting or after an initial (or several) non-blood bouts of emesis

38
Q

in what percent of patients will Hx and PE suggest a dx in?

A

> 50%

39
Q

is confirmatory testing required?

A

yes.

40
Q

what labs do you get for GI bleed?

A
  1. CBC w/ diff
  2. type and cross-match *
  3. coagulation profile
  4. FOBT
  5. liver tests (AST, ALT, bilirubin, alk phos, albumin)
  6. BMP
  7. iron and ferritin
41
Q

what can you sometimes do in a patient with a suspected upper GI bleed?

A

Nasogastric aspiration and lavage

42
Q

what is the GOLD STANDARD test for an upper GI bleed?

A

upper endoscopy/EGD

43
Q

what is the purpose of a upper endoscopy/EGD?

A
  • examination of esophagus, stomach, and duodenum
  • diagnostic and therapeutic
44
Q

what can a flexible sigmoidoscopy and anoscopy be used for?

A

typical sx hemorrhoidal bleeding

45
Q

what is the GOLD STANDARD test for a lower GI bleed?

A

colonoscopy

46
Q

whats the purpose of a colonoscopy?

A

often done electively after routine preparation
significant bleeding- rapid prep delivered via NG tube for patients with hematochezia

47
Q

when is a CT angiography done?

A
  1. bleeding rate of at least 0.5-1 mL/min is required for detection
  2. reserved for patients who cannot undergo endoscopy d/t hemodynamic instability
48
Q

what is the first 2 steps of treatment for GI bleed?

A

secure airway- intubation may be required
2 large-gauge peripheral IV’s and/or central line
- IV fluid rescuscitation
- blood transfusion (Hgb <7)
>packed RBCs, platelets, FFP

49
Q

are GI bleed management patients NPO?

A

yes
- you’ll also consult GI and/or gen surgery

50
Q

what are the 3 pharamacotherapy options for GI bleed tx?

A
  1. IV PPI for all upper GI bleed
  2. octreotide for variceal bleeding
  3. prophylactic abx for suspected variceal bleeding in pt w /cirrhosis (prevention of spontaneous bacterial peritonitis)WH
51
Q

what is hermostasis?

A

GI bleeding stops spontaneously in roughly 80% of patients
specific hemostatic therapy depends on bleeding site

52
Q
A

GI (22 decks)

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