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Flashcards in GI Bleeding Deck (30)
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1
Q

Hematochezia =

A

stools w/ obvious blood (bright red, maroon, currant jelly)

2
Q

Loss >40% blood volume will cause ____

A

supine hypotension

3
Q

Loss ~15% blood volume will cause ____

A

orthostatic drop in SBP > 20 mmHg +/- increase HR of >20 bpm

4
Q

T/F: Hemoccult/gastroccult is helpful in diagnosing an acute GI bleed.

A

False. Not helpful acutely

5
Q

T/F: Hemoglobin/hematocrit is NOT reliable in acute bleed

A

True

6
Q

_____mL of blood in UGI tract causes melena

A

50-100 mL

7
Q

BUN/creatinine >20 → (UGI/LGI) source

A

UGI

8
Q

Blood clots in stool → (UGI/LGI) source

A

LGI

9
Q

T/F: Varices are painful

A

False. Ulcers are painful

10
Q

Secondary Aortoenteric Fistula is most common when?

A

Post repair of aortic aneurysm

11
Q

Herald bleed = a warning sign of what?

A

exsanguinating hemorrhage if AEF is not identified in timely fashion

12
Q
Which of the following is NOT a cause of massive bleeding?
A. Diverticular bleed
B. Hemorrhoids
C. Ischemia
D. Arteriovenous malformation
A

B. Hemorrhoids are chronic, less dramatic bleeding. So are colon cancers and IBD

13
Q

History of diarrhea suggests ____

A

IBD

14
Q

“Wipe” bleeding, anal discomfort suggests ____

A

hemorrhoids

15
Q

Most common anomaly of GI tract

A

Meckel’s diverticulum

16
Q

Protrusion of mucosa and submucosa through weak spots in circular muscle =

A

Diverticula

17
Q

Occult GI bleeding is detected by ____ (2)

A

iron deficiency or + fecal occult blood test

18
Q

Occult GI bleeding is typical of ____

A

early colon cancers

19
Q

Overt or occult bleed that persists or recurs after initial negative endoscopic/colonoscopic evaluation =

Approach for evaluation?

A

Obscure GI bleeding
Confirm negative endoscopies → focus on potential small bowel source via video capsule endoscopy, deep enteroscopy, angiography, CT enterography

20
Q

Which of the following is/are NOT a characteristic(s) of iron deficiency in adults?
A. Iron supplementation is sufficient approach
B. Decreased ferritin
C. Low MCV
D. Decreased transferrin

A

A. MUST work up for occult blood loss

D. compensatory increase in transferrin/TIBC

21
Q

Treatment for acute variceal bleeding

A

IV octreotide

22
Q

Laser, argon plasma coagulators, injection of epinephrine, ligation or gluing of varices are treatment options for ____

A

superficial mucosal lesion

23
Q

T/F: Surgery for ulcer bleeding is a first line option of treatment.

A

False. Only for failure of nonsurgical RX for ulcer bleeding

24
Q

T/F: Urgent colonoscopy in LGI bleeding reduces mortality, hospital stay, transfusion requirements… etc.

A

False. Statement true for urgent UPPER endoscopy in UGI. Urgent colonoscopy in LGI bleeding not as helpful

25
Q

T/F: If massive bleeding and can’t stabilize, perform an endoscopy to find out the source of the bleed.

A

False. Do NOT do endoscopy, consider alternatives.

26
Q

Which of the following is TRUE about angiography?
A. REQUIRES active bleeding of at least 0.1 - 0.5 ml/min to identify bleeding site
B. Requires bowel prep
C. Procedure of choice in hemodynamically unstable pts

A

C

A. 0.5-1.0 ml/min
B. Does NOT require bowel prep

27
Q

T/F: Angiography is more sensitive that tagged RBC scan.

A

False. RBC scan requires less active bleeding (0.1-0.5 ml/min vs 0.5-1.0 ml) than angiography

28
Q

Which of the following is FALSE about the tagged RBC scan?
A. REQUIRES active bleeding of at least 0.1-0.5 ml/min
B. Useful in localizing bleeding site
C. Helpful for evaluating intermittent bleeding
D. Can re-image every few hours as needed

A

B. Difficult to localize.

29
Q
Which of the following is NOT a cause of small bowel bleeding?
A. Angioectasias
B. IBD
C. NSAID enteropathy
D. Gastroantral vascular ectasia 
E. Meckel's diverticulum
A

D. GAVE is a cause of upper GI bleed.

Angioectasia = arteriovenous malformation (common in older pts)

30
Q
Which of the following is NOT a cause of upper GI bleeding?
A. Vascular ectasias
B. Arterial venous malformation
C. Dieulafoy's lesion
D. Meckel's diverticulum
A

D. Meckel’s diverticulum is a cause of small bowel bleeding