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GASTROENTEROLOGY > GI BLEEDING > Flashcards

GI BLEEDING Flashcards

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1
Q

Most common cause of UGIB

A

Peptic ulcers

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2
Q

3 high risk findings of ulcer on endoscopy

A
  • Active bleeding
  • Nonbleeding visible vessel
  • Adherent clot
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3
Q

High-dose, constant infusion of IV PPI sustain intragastric pH of:

A

> 6

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4
Q

Rebleeding percentage of peptic ulcers within the next year if no preventive strategies done

A

10-50%

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5
Q

3 main factors in ulcer pathogenesis:

A
  • Helicobacter pylori
  • NSAIDs
  • Acid
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6
Q

Eradication of H. pylori decrease PUD rebleeding to:

A

< 5%

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7
Q

If necessary, what NSAID would you give in patient with GIB?

A

COX-2 selective plus a PPI

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8
Q

For GIB patients with CVD who takes low-dose aspirin for secondary prevention, when will you resume aspirin?

A

Restart aspirin ASAP after their bleeding episode (1-7 days)

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9
Q

For GIB patients who take aspirin for primary prevention, when will you resume aspirin?

A

No need to resume

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10
Q

If GIB is unrelated to H. pylori or NSAIDS, until when should you give PPI to patients?

A

Should remain on PPI therapy indefinitely because of rebleeding rates of 42% at 7 years

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11
Q

Most common bleeding site of Mallory-Weiss tear

A

Gastric side of the GEJ

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12
Q

Mallory-Weiss tear stops spontaneous in how many percent of cases?

A

80-90%

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13
Q

Recurrence rate of Mallory-Weiss Tear

A

0-10%

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14
Q

Poorer outcomes than other sources of UGIB

A

Esophageal varices

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15
Q

4 treatment for Esophageal varices

A
  • Endoscopic ligation
  • IV vasoactive medications
  • Non-selective beta blockers
  • TIPS
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16
Q

2 indications of TIPS in patient with BEV:

A
  • For patients with persistent or recurrent bleeding despite endoscopic and medical therapy
  • 1st 1-2 days of hospitalization for acute BEV in patients with advanced liver disease (Child-Pugh class C with score 10-13)
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17
Q

Endoscopically visualized breaks that are confined to the mucosa

A

Erosive disease

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18
Q

Cause of erosive esophagitis

A

GERD

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19
Q

Most important cause of gastric and duodenal erosions

A

NSAID use

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20
Q

Watermelon stomach

A

Gastric antral vascular ectasia

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21
Q

Aberrant vessel in mucosa bleeds from a pinpoint mucosal defect

A

Dieulafoy’s lesion

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22
Q

Hereditary hemorrhagic telangiectasias

A

Osler-Weber-Rendu

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23
Q

Prolapse of proximal stomach into esophagus with retching

A

Prolapse gastropathy

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24
Q

Bleeding from the bile duct

A

Hemobilia

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25
Bleeding from pancreatic duct
Hemosucus pancreaticus
26
Percentage of obscure GIB that originate in the small intestine
~75%
27
3 most common causes of small-intestinal GIB in >40 years old:
* Vascular ectasias * Neoplasm * NSAID-induced erosions and ulcers
28
Most common cause of significant small intestinal GIB in children
Meckel diverticulum
29
Most common cause of LGIB
Hemorrhoids
30
Aside from hemorrhoids and anal fissures, what is the most common cause of LGIB?
Diverticulosis
31
Usual location of diverticulosis
Right colon
32
Bleeding stop spontaneously in how many percent of diverticulosis?
~80-90%
33
Rebleeding rate in diverticulosis
~15-40%
34
Without source of GIB identified on UGIE and colonoscopy
Obscure GIB
35
Bleeding vascular ectasias and aortic stenosis
Heyde’s syndrome
36
2 most common causes of significant colonic GIB in children and adolescents
* Inflammatory bowel disease | * Juvenile polyps
37
Measurement of these 2 is the best way to initially assess a patient with GIB
Heart rate and BP
38
It may take up to how many hours for Hgb to fall in acute GIB
72 hrs
39
Hemoglobin does not fall immediately in acute GIB. Why?
Proportionate reductions in plasma and red cell volumes
40
Transfusion is recommended once Hgb is _____. And what do you call this strategy?
* ≤ 7 g/dL | * Restrictive transfusion strategy
41
In melena, blood has been present in the GIT for how many hours?
≥ 14 h or as long as 3-5 days
42
Aside from melena, what are 2 other clues of UGIB in differentiating with LGIB?
* Hyperactive bowel sounds | * Elevated BUN
43
3 baseline characteristics predictive of rebleeding and death in UGIB:
* Hemodynamic compromise * Increasing age * Comorbidities
44
Promotility agent to improve visualization? Dose?
Erythromycin 250 mg IV ~ 30 min before endoscopy
45
In what subset of UGIB patients will you give antibiotics? And what antibiotics?
* Cirrhotic | * Quinolone or ceftraixone
46
May improve control of bleeding in cirrhotics with UGIB in the 1st 12 h after presentation
IV vasoactive medications
47
When should you perform upper endoscopy? In high-risk patients?
* Within 24 hrs | * Within 12 hrs
48
BUN scoring in Glasgow- Blatchford score
* 18.2 to <22.4 = 2 * 22.4 to <28.0 = 3 * 28.0 to <70.0 = 4 * ≥ 70 = 6
49
Hemoglobin scoring in Glasgow- Blatchford score (men and women)
* 12 to <13 (men) = 1 * 10 to <12 (women) = 1 * 10 to <12 (men = 3 * <10 = 6
50
SBP scoring in Glasgow- Blatchford score
* 100-109 = 1 * 90-99 = 2 * <90 = 3
51
Heart rate scoring in Glasgow- Blatchford score
≥ 100 = 1
52
Scoring of other markers in Glasgow- Blatchford score
* Melena = 1 * Syncope = 2 * Hepatic disease = 2 * Cardiac failure = 2
53
In patients with hematochezia + hemodynamic instability, what procedure should you do first?
UGIE to rule out UGIB
54
Procedure of choice for LGIB, unless bleeding is too massive
Colonoscopy
55
Procedure for massive LGIB
Angiography
56
Procedure for LGIB in patients < 40 years old with minor bleeding
Sigmoidoscopy
57
Initial test in patients with massive bleeding from the small intestine
Angiography
58
Next step in patients with GIB with negative UGIE or colonoscopy
* Second-look procedure – repeat upper and lower endoscopy | * May also do push enteroscopy
59
Inspect the entire duodenum and proximal jejunum with a pediatric colonoscope
Push enteroscopy
60
If second-look procedure in GIB patient is negative, what is the next step?
Video capsule endoscopy (may also do push enteroscopy)
61
May be used initially instead of video capsule in patients with possible small bowel narrowing
CT enterography
62
If capsule endoscopy is negative, what is the next step?
Observe or do further testing with deep enteroscopy
63
Next step if you have a positive FOBT:
Do colonoscopy

GASTROENTEROLOGY (2 decks)

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