GI bleeding and jaundice

Question 1

hematemesis

Answer 1

vomiting red blood or coffee grounds material

Question 2

melena

Answer 2

black, tarry foul smelling stool

Question 3

hematochezia

Answer 3

passage of bright red or maroon blood from the rectum

Question 4

occult blood

Answer 4

absence of overt bleeding but presence of iron deficiency or positive fecal blood test.

Question 5

common symptoms of anemia

Answer 5

lightheadedness, syncope, angina, dyspnea.

Question 6

common causes of upper GI bleed

Answer 6

ulcers, varices, gastroduodenal erosions, mallory-weiss tears, erosive esophagitis, neoplasm, vascular ectasia, no source.

Question 7

what does hematemesis tell us

Answer 7

there is probably an upper GI source, above the ligament of treitz

Question 8

what does melena tell us

Answer 8

blood present in the GI tract for at 12-14 hours and as long as 3-5 days

Question 9

what does hematochezia tell us

Answer 9

usually from a lower GI source or from a brisk UGI source in patients that are hemodynamically unstable.

Question 10

melena or hematochezia

Answer 10

small bowel source

Question 11

what is the most common presentation of UGIB

Answer 11

hematemesis and melena, hematemesis, melena

Question 12

what is the most common cause of UGIB

Answer 12

peptic ulcer.

Question 13

what are the causes of peptic ulcers

Answer 13

NSAIDs and H pylori

Question 14

mallory-weiss tears

Answer 14

vomiting, retching, coughing preceeding hematemesis, especially in alcoholic patient.

Question 15

esophageal varices

Answer 15

suspect with cirrhosis, poorest outcome among all UGIB.

Question 16

hemorrhagic and erosive gastropathy/gastritis

Answer 16

cause mucosal lesions and thus not major bleeds. they are associated with alcohol and NSAID use.

Question 17

what is the medical therapy for peptic ulcer bleed

Answer 17

proton pump inhibitor, h pylori eradication, avoidance of NSAIDs,

Question 18

risk of rebleeding for ulcer s

Answer 18

active, visible vessel, adherent clot, flat spot or pigmented, clean based ulcer,

Question 19

how do we stop peptic ulcer bleeds

Answer 19

need platelet aggregation and fibrin formation which requires pH > 6.8 PPI will keep the pH in correct range. they are effective in peptic ulcer bleeding

Question 20

what is the most effective treatment for bleeds

Answer 20

proton pump inhibitors and endoscopy treatment.

Question 21

how do small intestinal bleeds present

Answer 21

melena or hematochezia

Question 22

what are the most common causes of small intestinal bleeds

Answer 22

vascular ectasia, tumors, NSAID erosions or ulcers.

Question 23

what is the most common cause of LGIB in children?

Answer 23

Meckels diverticulum.

Question 24

what are the most common causes of LGIB

Answer 24

hemorrhoids and anal fissures. diverticula, vascular ectasia, neoplasm, colitis,

Question 25

what are the most common causes of LGIB in children

Answer 25

inflammatory bowel disease and juvenile polyps.

Question 26

characteristics of a diverticula bleed

Answer 26

abrupt onset, painless, massive LGIB, stops spontaneously in 80% of cases and rebleeds in 20-25%

Question 27

jaundice

Answer 27

yellowish discoloration of tissue resulting from the deposition of bilirubin, sign of liver dysfunction or hemolytic disorder.

Question 28

bilirubin metabolism

Answer 28

metabolite of heme, provides color to bile, stool, urine.

Question 29

does unconjugated bilirubin enter the glomerular filtrate

Answer 29

no. it binds albumin with high affinity.

Question 30

bilirubinemia

Answer 30

elevation of conjugated bilirubin fraction and thus liver disease.