GI Bleeding Flashcards Preview

Surgery/ER Fall 2013 > GI Bleeding > Flashcards

Flashcards in GI Bleeding Deck (59):
1

ligament of tretz

proximal to ligament of treitz- upper GI bleeding. distal to ligament of treitz- lower GI bleeding

2

ligament of treitz separates

duodenum from jejunum

3

UGI bleeding prognosis

self limited in 80%. remaining 20%- medical therapy and EGD

4

causes of acute UGI bleeding

PUD (most common), portal HTN, mallory weiss tear, vascular anomalies, gastric neoplasm, erosive gastritis, erosive esophagitis

5

incidence of bleeding from peptic ulcer dz is decreasing d/t

tx of h. pylori and tx with PPI's

6

tx of portal hypertension

IV octrotide infusion

7

portal HTN causing acute UGI bleeding most often d/t

varices (esophageal, gastric, duodenal)

8

tears at the GE junction d/t retching

mallory-weiss tears

9

mallory -weiss tears most commonly occur in what type of patients?

alcoholics and bulemics

10

vascular anomalies causing acute UGI bleeding include

angioectasias (1-10 mm dialted submucosal vessels), telangectasias (dilated venules), and Dieulafoy's lesions (dilated artery in proximal stomach)

11

angioectasias most common in

right colon

12

erosive gastritis causing acute UGI bleeds d/t

NSAIDS, alcohol, or severe medical or surgical illness

13

erosive esophagitis causing acute UGI bleeds (rare) results form

chronic GERD

14

Is hgb/hct helpful in determing severity in GI bleeding?

may take 1-3 days to equilibrate so do not rely on this value

15

management/tx of acute UGI bleed

strat with looking at VS (Hgb, BP, PP, HR,, UO, MS). if normal, check orthostatics. Get labs- CBC, PT, chem 7, LFT, type and screen. Hook up 2 large bores- IVF. type and cross 2-4 units if severe bleeding. CVP monitoring, NG tube. risk stratification to determine EGD within 2-4 hours or within 24 hours

16

If need to clear stomach in case of upper GI bleed

don't do gastric lavage. use IV erythromycin to clear stomach

17

NG aspirate of red blood or coffee grounds=

confirms UGI source of bleeding.

18

Bright red blood vs. clear aspirate from NG tube

high risk of complications. if clear= duodenal source of bleeding

19

blood replacement in acute UGI bleeding

Hgb should raise 1 gram for each unit of PRBC's given. In massive bleeding, give 1 unit FFP for every 5 units of PRBC's.

20

when is FFP given in acute UGI bleeding

If massive bleeding or if patient with coagulopathy

21

when are platelets transfused in acute UGI bleeding?

if less than 50,000 or if patient has taken ASA or clopidogrel

22

when is DDAVP given in acute UGI bleeding

uremic patients

23

Hgb should be kept in range of ___ in acute UGI bleeding replacement

6-10

24

low risk- acute UGI bleeding

no evidence of active bleeding. admit to GMB or stepdown. EGD within 24 hours.

25

high risk indications and management - acute UGI bleeding

hematemesis, bright red blood per NG, shock, advanced liver disease, hypovolemia unresponsive to resuscitation. serious comorbid disease. ADMIT TO ICU, EGD WITHIN 2-4 HOURS

26

History is only 40% accurate, so __ used to identify source of bleeding in acute UGI bleeds

EGD

27

meds for acute UGI bleeding

IV "prazole" (PPI) or high dose oral PPI prior to EGD. intra-arterial embolization, TIPS, surgery

28

95% of LGI bleeding is from

colon

29

most common cause of LGI bleed

diverticulosis

30

most common cause of UGI bleed

peptic ulcer disease

31

what increases risk of diverticulosis

ASA and NSAIDS

32

causes of acute LGI bleeding

diverticulosis, angioectasias, neoplasms, IBD, anorectal disease, ischemic colitis, infectious colitis

33

most common to see those over 70 yo and in patients with renal failure (acute lower Gi bleeding cause)

angioectasias

34

BRBPR in patients over 50, PAINLESS

diverticulosis

35

most common diagnostic instruments to determine source of bleeding in UGI and LGI bleeds

EGD, colonoscopy. If massive LGI bleeding in hemodynamiccally unstable patient, do angiography

36

diarrhea w/intermittent hematochemize, abd pain, tenesmus, urgency of stool

IBD

37

bright red blood that drips into toilet after BM

anorectal disease (hemorrhoids, fissures, stercoral ulcers)

38

where does ischemic colitis occur

"watershed" areas of colon

39

Diagnosis of acute lower GI bleed

1. exclude UGI source. 2 anoscopy/sigmoidoscopy. 3. colonoscopy 4. tagged RBC scan 5. angiography 6. small intestine push enteroscopy 7. capsule endoscopy

40

how to exclude UGI source in diagnosis of LGI bleed

if unstable patient, NG tube for aspiration. EGD performed in patients with hematochezia and hemodynamic instability

41

If patient presents with LGI bleeding, is younger than 45, and has small volume bleeding-->

anoscopy/sigmoidoscopy to look for anorectal dz, IBD, infectious colitis

42

bowel prep done in most cases for colonoscopy- this is performed within 24 hours vs. 2 hours if...

24 hours if bleeding minimal. within 2 hours of prep if bleeding severe

43

embolization of bleeding vessel effectively stops bleeding in 95%. but complication rate 5%-

ischemic colitis

44

acute lower GI bleeding diagnostic instrument used to identify lesions in small intestine

push enteroscopy

45

negatives of capsule endoscopy

gretaer potential for hemorrhage, hard to locazline bleeding site

46

tx for acute LGI bleeding

colonoscopy (cautery), angiography with embolization, surgical tx

47

surgical tx indications in acute LGI bleeding tx

ongoing bleeding, or if transfusion requirements are more than 6 units in 24 hours, or if 2 or more hospitalizations for diverticular hemorrhage

48

segmental colon resection vs. subtotal colectomy

if preoperative localization done by antiography or tagged RBC scan, then segmental colon resection. if source of LGI bleed cannot be localized, do subtotal colectomy

49

obscure Gi bleeding -

bleeding of unknown origin that persists or recurs after negative EGD and colonoscopy

50

obscure GI bleeding most commonly arises from lesions in

small intestine. (1/3 are missed lesions of stomach or colon)

51

etiology of Obscure GI bleeding

if over 40, NSAID induced or angioectasias. if uncer 40, SB neoplasm, crohn's, celiac dz, meckel's diverticulum

52

evaluation of younger patients and symptomatic older patients for obscure GI bleeding

EGD and colonoscopy to r/o missed lesion, capsule endoscopy if scopes are negative. add meckel's scan if younger than 30

53

occult Gi bleeding is how much

less than 100 ml/day (not apparent to patient)

54

occult GI bleeding identified by

FOBT or iron deficiency anemia (serum ferritin less than 30-45 mcg/L

55

occult GI bleeding that is asymptomatic , positive FOBT

colonoscopy

56

occult GI bleeding that is symptomatic, positive FOBT

colonoscopy and EGD

57

if patient is greater than 60 without symptoms of occult GI bleeding, mange---

trial iron supplementation and observe. if no response, pursue a small bowel source

58

if patient greater than 60 and symptomatic or less than 60, manage...

pursue evaluation of small bowel

59

occult Gi bleeding- STOP

nsaids, asa, clopidogrel