gi bleeding Flashcards
(32 cards)
define upper gi bleeding
hemorrhage from any source between the pharynx and teh ligament of treitz
characteristics of upper gi bleed
hematemesis and melena
causes of upper gi bleeding
esophageal vaices mallory-weiss tears esophageal rupture boerhaave's syndrome bleeding gastric varices angiodysplasia cancer
in patients with liver cirrhosis 50-60% of UGI bleeding is due to
perforation or rupture of esophageal varices
in the event of a ruptured esophageal varices, what needs to be managed?
stop blood loss
maintain plasma volume
correct disorders in coagulation induced by cirrhosis
appropriate use of abx (infection by gram-negative organisms is commonly a concomitant)
blood volume resuscitation
blood volume resuscitation can lead to
increase in portal pressure—> more bleeding
worsen ascites
UGI bleed due to peptic ulcer disease often present with
hematemesis
coffee ground vomiting
melena
hematochezia
other complications due to UGE bleed from PUD
anemia fatigue chest pain syncope SOB
isolated melena may originate anywhere from the ______ to the ______
esophagus
proximal colon
what increases risk for peptic ulcers
h. pyloric infxn ASA and NSAIDs SSRIs corticosteroids anticoagulants
labs to evaluate UGI bleed
CBC
coagulation time
electrolytes
what is used to dx upper GI bleed
emergency upper endoscopy
Glasgow-Baltchford score
systolic B/P: 100-109---> 1 90-99------> 2 3 hemoglobin (men): 12-13----> 1 10-12----> 3 6 hemoglobin (women): 10-12----> 1 2 blood urea: 6.5-8----> 2 8-10------> 3 10-25----> 4 >25-------> 6 other markers: pulse >100----> 1 melena---------> 1 syncope-------> 2 hepatic dz----> 2 cardiac fx-----> 2
Glasgow-Blatchford score is equal to 0 if all of the following are present:
hemoglobin level >12.9 (men) or >11.9 (women)
systolic BP >109
pulse >100
serum BUN
true or false: death in those pateitns with a GI bleed is more commonly due to other illnesses
true
define a lower GI bleed
occurs distal to the ligament of treitz (last 1/4 of the duodenum, entire jejunum, ileum, colon, rectum, anus)
causes of lower GI bleed
diverticulosis/diverticulitis crohn's dz UC ischemic colitis infectious colitis (esp. E. coli, shigella, salmonella, campylobacter) angiodysplasia neoplasm, polyps, cancer hemorrhoids
melena indicates blood that has been in the GI tract for at least ___ hours
8
what is the sign of a significantly active GI bleed
hematochezia (bright red or maroon colored stool)
maroon stools are associated with which side of the colon? bright red blood?
maroon from right side
bright red from left side
diverticula are most commonly located where?
sigmoid
descending colon
(left side of colon)
are left sided or right sided diverticula responsible for the majority of bleeding?
right sided (50-90%)
colorectal adenocarcinoma is the ____ mc cancer in the US
3rd
ischemic colitis frequently involes
the watershed areas—> splenic flexure and recto-sigmoid junction
