GI - GI bleed Flashcards
(29 cards)
A source of bleeding above the ligament of Treitz in the duodenum
upper GI bleed
Classically defined as bleeding below the ligament of Treitz
Lower GI bleed
Black, tar like stool with a strong offensive odor due to degradation of hemoglobin by bacteria in the colon
melena
Causes of dark stool other than bleeding
- bismuth
- iron
- spinach
- charcoal
- licorice
Suggests upper GI bleeding with a lower rate of bleeding.
“coffee grounds” emesis
The passage of bright red or maroon blood per rectum with or without stool, most commonly caused by a lower GI bleed (typically left colon or rectum)
Hematochezia
Melena is usually caused by
Upper GI bleed
Causes for upper GI bleeding
- peptic ulcer disease
- reflux esophagitis
- esophageal/gastric varices
- gastric erosions
- Mallory Weiss tear
Submucosal dilated arterial lesions that can cause massive GI bleeding
Dieulafoy’s vascular malformation
Causes of lower GI bleeding
- diverticulosis
- angiodysplasia
- IBD (Crohn or UC)
- CRC
- ischemic colitis
- hemorrhoids/anal fissures
- small intestinal bleeding
Indications for transfusion in a GI bleed
- packed red blood cell transfusion if Hb <7
- higher threshold may be considered in patients with pre-existing CV disease
This study is used to identify the source of GI bleeding and simultaneously control the bleed typically performed in patients with massive, life-threatening GI bleed who cannot be stabilized for further diagnostic testing.
CT angiography (CTA)
This test allows for rapid bleeding source localization to help target hemostatic interventions; can be therapeutic when combined with angioembolization or intra-arterial vasopressin infusion
CT angiography
This is a last resort for GI bleeds indicated for patients with persistent or recurrent GI bleeding that is unresponsive to endoscopic therapy and causes hemodynamic instability despite repeated transfusions.
Emergent laparotomy
Diagnostic procedure using a wireless camera inside a capsule that is swallowed by the patient to visualize the small bowel.
Capsule endoscopy
A nuclear medicine procedure that involves radio labeling RBC with technetium-99 and subsequent imaging. It can reveal bleeding with a low rate of blood loss, but cannot localize the lesion (only identifies continued bleeding).
Tagged RBC scintigraphy
This scan may be ordered for patients with ongoing LGIB that cannot be localized with colonoscopy or CTA
Tagged RBC scintigraphy
A radiographic imaging technique for evaluation of the small bowel.
CT enterography
An enteroscopic technique that involves insufflating and deflating two balloons to move an enteroscope and its overtube along the small bowel for visualizing the entire small bowel.
Double-balloon enteroscopy (push and pull enteroscopy)
Initial best study for upper GI bleed in a hemodynamically unstable patient
EGD or mesenteric angiography is EGD is not possible
Most accurate diagnostic test in evaluation of an upper GI bleed
Upper endoscopy (EGD)
This test is first line for upper GI bleeds because it is both diagnostic and therapeutic
Upper endoscopy (EGD) - can coagulate bleeding vessel during endoscopy
Most patient with upper GI bleeding should have upper endoscopy within ____ hours
24 hours
Initial best test for upper GI bleed in a hemodynamically stable patient
EGD. If EGD is non-diagnostic, colonoscopy after bowel prep or CTA
