GI bleeds

Question 1

Upper gastrointestinal bleeding is defined as hemorrhage from any source between —-?

Answer 1

the pharynx and the ligament of Treitz, which connects the fourth portion of the duodenum to the diaphragm near the splenic flexure of the colon.

Question 2

About 75% of patients presenting to the emergency room with GI bleeding have an _____ source.

Answer 2

upper. 40% to 50% of patients in the emergency room with GI bleeding have an upper source

Question 3

upper GI bleec characterised by?

Answer 3

hematemesis and melena and the diagnosis is made more easily when the patient has hematemesis.

Question 4

top 3 causes of bleeds

Answer 4

Approximately 50% of upper GI bleeds are due to 1. peptic ulcer disease.
2. Esophagitis and 3. erosive disease of the esophagus causing bleeding are the next most common causes.

Question 5

Other causes of UGI bleeding include:

Answer 5

bleeding esophageal varices, Mallory-Weiss tears, esophageal rupture, Boerhaave’s syndrome, bleeding gastric varices, angiodysplasia and cancer.

Question 6

In patients with liver cirrhosis 50–60% of UGI bleeding is due to __________

Answer 6

perforation or rupture of esophageal varices.

Question 7

esophageal veins take which route?

Answer 7

carry deoxygenated blood from the esophagus to the azygos vein, which in turn drains directly into the superior vena cava. DONT form varices

Question 8

superficial esophageal veins

Answer 8

drain into the left gastric vein which in turn drains directly into the portal vein.

Question 9

sueprficial esophageal vein varices associated with?

Answer 9

Portal HTN

Question 10

precipitating conditon requiring antibiotics?

Answer 10

infection by gram-negative organisms

Question 11

complications of blood resucitation

Answer 11

can lead to an increase in portal pressure leading to more bleeding.
Volume resuscitation can also worsen ascites

Question 12

mainstay of tx?

Answer 12

endoscopy

Question 13

two main therapeutic approaches

Answer 13

are variceal ligation (or banding) and sclerotherapy.

Question 14

in cases of refractory bleeding

Answer 14

balloon tamponade is used to try and stem bleeding and stabilize the patient.

Question 15

Boerhaave’s syndrome location/mechanism

Answer 15

the tear occurs at the left posterio-lateral aspect of the distal esophagus and extends for several centimeters.

Spontaneous perforation of the esophagus most commonly results from a sudden increase in the intra-esophageal pressure combined with negative intra-thoracic pressure.

Question 16

mc causes of boerhaave’s

Answer 16

This is most often caused by straining, coughing or vomiting. Other causes of spontaneous perforation include caustic ingestion, pill esophagitis, Barrett’s ulcer, infectious ulcers in patients with AIDS, and following dilation of esophageal strictures

Question 17

Esophageal rupture

Answer 17

of the esophageal wall. Iatrogenic causes account for approximately 50-60% of esophageal perforations, usually due to medical instrumentation such as an upper endoscopy.

In contrast, the term Boerhaave’s syndrome is reserved for the approximately 10% of esophageal perforations which occur due to severe vomiting or severe coughing.

Question 18

Gastric variceal bleeding

Answer 18

due to splenic vein thrombosis is a life-threatening situation

Question 19

GI bleed due to peptic ulcer disease often present with :

Answer 19

hematemesis, coffee ground vomiting, melena, or hematochezia
Patients may also present with complications of anemia, including fatigue, chest pain, syncope and shortness of breath

Question 20

Isolated melena origin

Answer 20

may originate from anywhere between the esophagus and the proximal colon

Question 21

medications found to cause upper GI bleeds.

Answer 21

ASA and the NSAIDs increase the risk about fourfold.

SSRIs, corticosteroids, and anticoagulants may also increase the risk.

Question 22

common ulcer location causing a bleed

Answer 22

posterior wall duodenal ulcer

Question 23

gastric aspiration

Answer 23

may be used to determine if there is blood in the stomach.

Question 24

Glasgow-Blatchford score

Answer 24

A GB score is equal to ”0” if all of the following are present:

• -Hemoglobin level >12.9 g/dL (men) or >11.9 g/dL (women)
• -Systolic blood pressure >109mm Hg
• -Pulse

Question 25

Glasgow-Blatchford scoring

Answer 25

Blood Urea Score | ≥6.5

Question 26

A lower GI bleed is defined as a:

Answer 26

bleed that occurs distal to the ligament of Treitz. This includes the last 1/4 of the duodenum and the entire area of the jejunum, ileum, colon, rectum, and anus. Less common than UGIB

Question 27

LGIB causes

Answer 27

``` Diverticulosis, diverticulitis Crohn’s disease Ulcerative colitis Ischemic colitis Infectious colitis esp. E. coli O157:H7, Shigella, Salmonella, Campylobacter jejunai Angiodysplasia Neoplasm, polyps, cancer Hemorrhoids ```

Question 28

Melena

Answer 28

Melena is four-times more likely to come from an upper gastrointestinal bleed than from the lower GI tract however, it can also occur in either the duodenum and jejunum. blood has been present for 8 hours

Question 29

Hematochezia

Answer 29

Bright red or maroon colored stool is the sign of a significantly active GI bleed. The presence of hematochezia is six-times more likely to represent a lower GI bleed than with an upper GI bleed.

Question 30

stool color related to bleed side

Answer 30

Maroon stools, with LGIB from the right side of the colon Bright red blood per rectum with LGIB from the left side of the colon Melena with bleeding from cecum and distal to cecum.

Question 31

how many lower GI bleeds involve the colon?

Answer 31

85%

Question 32

Diverticulosis and bleeds

Answer 32

Diverticula are most commonly located in the sigmoid and descending colon. Up to 20% of patients with diverticular disease experience bleeding, which stops spontaneously in 80% of patients; however, in 5% it can be massive.

Question 33

T or F, R sided diverticula are worse

Answer 33

T right-sided diverticula are responsible for approximately 50-90% of the bleeding in patients presenting with lower GI bleed secondary to diverticulosis. they are less common than L sided.

Question 34

LGIB bleeds and IBD

Answer 34

Crohn's disease is not as common a cause as in patients with ulcerative colitis; 1-2% of patients with Crohn's disease may experience massive bleeding.

Question 35

ischemic colitis involves which areas?

Answer 35

splenic flexure and the recto-sigmoid junction.

Question 36

infectious colitis caused by?

Answer 36

may be due to either colonic tissue invasion by bacteria, such as Salmonella and Shigella, or toxin-mediated damage, as with Escherichia coli 0157:H7.

Question 37

Colonic angiodysplasias are_____?

Answer 37

arteriovenous malformations located in the cecum and ascending colon.

Question 38

angiodysplasia pathophys

Answer 38

Over time, mucosal capillaries dilate, become incompetent, and form an arteriovenous malformation. degenerative lesions that arise from chronic, intermittent, low-grade colonic contraction that obstructs the mucosal venous drainage.

Question 39

LGIB risk factors for incr mortality

Answer 39

poor renal function (creatinine > 150 ), age over 60 years, abnormal, low BP and persistent bleeding within the first 24 hours of presentation are notable risk factors for increased morbidity and mortality.

Question 40

intervention of choice for LGIBs? For stable and unstable pts...

Answer 40

Colonoscopy is the standard of care for diagnosis and often for therapeutic intervention. In hemodynamically unstable patients and in those with brisk ongoing LGIB, angiography with or without a preceding radionuclide scan can be performed.

Question 41

signs of massive LGIB?

Answer 41

Systolic blood pressure of less than 90 mm | Hemoglobin levels of

Question 42

main goals of LGIB management

Answer 42

Resuscitation and initial assessment. Localization of the bleeding site. Therapeutic intervention to stop bleeding at the site.

Question 43

treatments for various etologies of LGIB?

Answer 43

Diverticular bleeding: Colonoscopy with electric cauterization, epinephrine injection or placement of metallic clips Recurrent bleeding: Resection of the affected bowel segment. Angiodysplasia: Electrocoagulation or laser coagulation.

Question 44

The indications for surgery include the following:

Answer 44

Persistent hemodynamic instability with active bleeding. Persistent, recurrent bleeding. Transfusion of more than 4 units packed red bloods cells in a 24-hour period, with active or recurrent bleeding.

Question 45

Massive LGIB is defined as follows:

Answer 45

Passage of a large volume of red or maroon blood through the rectum Hemodynamic instability and shock Initial decrease in hematocrit (Hct) level of 6 g/dL or more Transfusion of at least 2 U of packed red blood cells (RBCs) Bleeding that continues for 3 days Significant rebleeding in 1 week