GIB Flashcards by Lux Smith

prevalence

Males: Females = 2:1

more alcoholic men

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UGI bleeding

30yo alcoholics –> varices

duodenal ulcers–> old rich people

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Tear in the esophagus after you vomit is known as

Mallory-Weiss

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mortality of GI bleeds

3-14%

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acute GI bleed continouse %

4/5 are fine

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What labs

CBC-
INR
CMP

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CBC, why do we get it and what are we looking at

a. Hemoglobin –> concentration per volume; even if you lose half your blood volume, your hemoglobin will be the same

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why can you see normal hemoglobin

—> concentration per volume; even if you lose half your blood volume, your hemoglobin will be the same

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the ratio of the volume of red blood cells to the total volume of blood.

Hematocrit

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why do you see changes with chronic bleeding

c. If you have been chronically bleeding you will hold onto WATER (not blood or cells)

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who dies from a GI bleed

Shock, red blood; low BP
Cause of bleeding (varices or cancer very bad)
a. The cause does effect your risk
i. Cirrhotic –> poor prognosis
Comorbid disease
Older age
Onset in hospital
Recurrent bleeding

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why do you see varicies in alcoholics

Increase in portal vein you get esophageal and stomach varices

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how does an NG tube work

o Withdrawal of blood is diagnostic for UGIB

oInsight as to acuity/ severity of bleed (coffee grounds, BRB, negative)

oAllows for clearance of stomach which can:
- Reduce risk of aspiration
- Clears the view for EGD
o”Easy” to place with little risk of complication

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cons of a NG tube

o Uncomfortable
o Potential false negative if post-pyloric source
o Risk for sinusitis or bronchus placement

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black stool usually indicative of

melena (bleeding is higher up; upper GIB –> blood gets acted on by bacteria in your colon which changes its color)

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why would you see dark stool with a lower gib

Cecum is the top of the colon and cancer here could cause bleeding that takes a while and is seen and black

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why would you see a red bleed with UGIB

has to be a HUGE volume of blood if its UGIB

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White stool

very very rare acholic stool (bile obstruction from pancreatic cancer)

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how much blood do you need for black stool

Only 50-100cc blood needed

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why is stool black

oxidation from bacteria

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Bright red blood per rectum AND blood in stomach

Bright red blood per rectum AND blood in stomach = that is a BAD UGIB

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If clear stomach and black stool

you will do reasonably well; were previously bleeding

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coffee grounds

oxidized blood

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If I drop an NG tube in your stomach, and there is bright red blood

that means you are actively bleeding = that is VERY BAD

a. Most common cause of UGIB

: PUD

4 major risk factors for GIB

major Risk Factors i. NSAIDs/ Aspirin ii. Helicobacter pylori infection iii. Physiologic Stress (i.e. hospitalized patients with life threatening illness) iv. Gastric Acid

Bleeding vessel is associated with what mortality

Bleeding vessel is associated with >10% mortality

most common PU that bleeds?

b. Gastric > Duodenal

most common stigmata with PUD

clean base

stigmats seen with peptic ulcers

``` clean base flat spot adherent NBVV Active bleed ```

NBVV stands for

i. NBVV --> nonbleeding visible vessel

chance of rebleeding with NBVV

Pts w/ NBVV has a 43% rebleeding risk

chance of bleeding again with active bleed

chance of rebleed with therapeutic endoscopy

20%

what are the benefits to endoscopic therapy

20-40% early discharge with loq risk money saving decreases rebleed by 50%

effect of pH on platelet aggregation

a. Reduced pH is associated with reduced platelet aggregation b. Clotting is pH dependent i. Blood doesn't like to clot at a pH of 1 1. Pepsin doesn't work 2. Platelets don't aggregate

acid and it's relationship to ulceration

acid causes ulcers

how to control acid and minimize bleeding

PPIs reduce rebleeding and need for surgery, but do not effect mortality compared to control h pylori eradication stop NSAIDS

how to minimize bleeding for low risk pt

stop taking NSAIDS and eradicate H pylori

how to minimize bleeding risk in a pt that is high risk

endoscopic tx PPI: prevention of stress related bleeding stop NSAIDS and eradicate H pylori maybe surgery

what is a low risk bleeding pt look like (endoscopy assessment)

clean base or flat spot | or adherent clot

what does a high risk pt look like (endoscopy assessment)

active bleed or visible vessel

what does initial assessment look like for a pt with a bleed (not endoscopy)

``` age greater than 60 comorbidity low bp red blood shock ongoing bleed prolonged cirrhosis erratic mental status ```

how many alcoholic cirrhosis or viral hepatitis pts get varices what is the mortality rate for these pts

1/4 of pts with and mortality in 30% pressures are higher in the hepatic vein and back up

tx for varices

banding and octreotide adjunct for suspected varices

octreotide

analog of somatostatin (in your body) synthesized protein that lowers portal pressure and lower bleeding it's an adjunct to scoping and banding

why are lower GI bleeds so difficult to find

very hard to stop diverticula bleeding because the cause is rarely identified to stream like an ulcer

AVM

arterial venous malformation talangectasia can be congenital can be caused by radiation

tx for lower GI bleed

no pharmocological tx surgery angiography (contrast) stop blood vessle through embolism but usually resolves on its own

occult bleeding tests

FOBT used to do GAUIAC but that can detect blood in digested food but now we do the FIT test (only measures human hemoglobin)

if you have a positive blood occult test what next

colonoscopy but most are just indicative of hemorrhoids

how could we assess bleeding in the small bowel

might want to use a capsule WCE small bowel bleeding or crohns

initial management

i. 2 large bore IVs ii. Bolus NS iii. Type and Cross blood iv. Labs

difference between hematocrit and hemoglobin

i. Hematocrit is calculated from hemoglobin This is a % of your blood that is blood cells

% of pt with rebleeding in order from highest occurance and mortality to lowest

``` varices gastric cancer peptic ulcers gastric erosions mallory weiss ```

what % of melena is from UGI

70-90% melena is from an UGI source

MCC of LGIB

``` diverticulitis then malignancy ischemic colitis IBD hemorrhoids post polypectomy ```

how many pts are controlled with LGIB treatment

no pharmological | therapeutic endocscopy only treats 20-30%

Tx for pt at high risk for UGIB

heal ulcer with PPI h pylori eradication stop NSAID