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Flashcards in GI bleeds Deck (34):
1

2 types of presentations of GI bleeds

1. overt
2. occult

2

3 types of overt bleeds

1. hematemesis (red or coffee grounds
2. melena
3. hematochezia

3

def. melena

- black maloderous stool caused by oxidation of blood in GI
- as little as 100mls
- can be caused by Fe tabs, pepto

4

what defines upper and lower GI

ligament of treitz- duodeno-jujenal angle

5

presentation of UG

melena or hematemesis
- chezia if bleed is brisk

6

presentation of LG

hematochezia
- can be melena if small bowel or right colon

7

4 common causes of UG

1. peptic ulcer disease
2. varices
3. esophagitis
4. mallory wiess

8

natural Hx of UGB

if non-variceal 80% stop on their own
- MandM more driven by CV factors

9

3 features that make you worried about massive bleed

1. hemo instability
2. hematochezia
3. high transfusion needs

10

3 features that make you worried about outcome

1. >60
2. concurrent illness
3. onset while hospitalized

11

UGB mgmt

- not immed. endo
- ABCs
- PPI
- correct coag.
- then endo

12

steps to resuscitation

1. protect airway
2. 2 large bore IVs
3. fluids
4. packed RBCs
5 ICU

13

aim of PPIs

correct acid
- higher pH causes clot stability
- in low pH platelets don't function as well
- pepsin at low pH can destry clot

14

when to give PPI

prior to endo - give bolus

15

3 roles of endo

1. diagnosis bleed
2. risk strat (pronosis)
3. treat lesion

16

types PUD from least risk to most (5)

1. clean base - low risk
2. flat spot - low
3. adhernet clot - intermediate
4. nonbleeding visible vessel - hihg
5. active bleed- high

17

what to do with risk levels

low - no endo therapy
high do endo therapy

18

3 types of endo treatments

1. thermal
2. mechanical (clips, band)
3. meds (injection sclerotherapy)

19

2 options to control if endo doesn't work

1. angiography with embolization
2. surgery

20

main cause of varices

increase in the portal system due to liver disease causes splanchnic vasodilation

21

required diff. for varcieal formation

12mmHg

22

when to suspect varices

- liver disease/alc
- esopha>> gastric
- cirrosis - predictiove of rebleeds

23

treatment of eso variceal bleeds

1. resuc
2. medical
- octereotide
- PPI
- prophylactic ABs
3. endo ligation
4. TIPPS shunt
5. if all else fails balloon tanponade

24

what is octreotide

somatostatin analog
- reduces blood flow to splanchnic circ.

25

what is different tretament option for gastric variceal bleeds

can use endo to glue

26

2 main presentations of LGB

1. hematochezia
2. melena

27

2 other important aspect to ask about with LGB

1. pain
2. constipation

28

when to suspect hematochezia is from UGB

- 10-15%
- when there is hemodynamic instability

29

what is MAIN cause of pain less LGB

divertiulosis
then
-hemor
- CA
meckels

30

1 cause of painful LGB

anal fissures

31

acute LBG mgmt

1. ABC
2. correct coagulopathy
3. colonscope
4. 80% stop without intervention

32

aims of scope for LGB

1. can ID lesion
2. sometimes treat

33

def. red cell scanning

put in radio red cells and look where they go

34

what is obscure GI bleeds

source no IDed as UG or LG - 5%
- usually small bowel

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