GIS BLEEDING

Question 1

CHRONIC hemorrhages are hidden and occur with…….

Answer 1

anemia

Question 2

in acute bleeding , it manifests as ………,………,and………..

Answer 2

hematemesis,melana,and hematochezia

Question 3

bloody vomit

Answer 3

hematemesis

Question 4

the color of the blood in the hematemesis depends on what?

Answer 4

-concentration of stomach acid
-contact time of the blood with the acid
-vomiting of fresh red blood

Question 5

mostly when we can see fresh red blood in the hematemesis?

Answer 5

-when it is very new
-rapid
-large amount
-suggestive of bleeding from the area far from the acidic environment

Question 6

Hb in the stomach ->oxidized ->by the effect of HCL -> vomiting like ………………..

Answer 6

coffee ground

Question 7

HEMATEMESIS always indicates …………..GI bleeding .

Answer 7

-upper GI bleeding

(but in the sever bleeding of lower part we can see it too)

Question 8

what is hemoptysis ?

Answer 8

when you cough up blood from your lungs

Question 9

HEMATEMESIS often accompanied by MELENA.true or false

Answer 9

true

Question 10

differentiation of HEMATEMESIS from………… is important

Answer 10

hemoptysis (cough of blood)

Question 11

MELENA definition

Answer 11

-Black, tar-like, sticky and runny, foul-smelling
defecation.
-excretion of digested blood.
- At least 50 ml of bleeding and it must remain in the
digestive tract for 8 hours.

Question 12

MELENA is a sign of ……………………….

Answer 12

-upper GI bleeding
(However, small bowel and proximal colon hemorrhages
◦ İf bowel passage is slow, it may cause a similar appearance.)
- In cases where the bleeding is too much and the
transit is too fast, a bleeding from the upper regions
may come out as red bleeding from the anus.

Question 13

the color of stool may change depending on the what?

Answer 13

-location of the bleeding
-the intestinal transit rate
-the amount and speed of bleeding

Question 14

less than half of those with MELENA also have ………………

Answer 14

hematemesis

Question 15

HEMATEMESIS may not be present in GI bleeding in case of ……………….

Answer 15

pyloric stenosis

Question 16

a 45 years old woman came in the emergency ,she complains of black stool and she afraid if it is MELENA ,but she has a history of using (charcoal, iron,bismuth) drugs ,and all of the other tests are normal ,what is your diagnosis ?

Answer 16

its the effect of Some drugs (charcoal, iron, bismuth) can stain stool
black

Question 17

After the bleeding has stopped, black stool may
continue for……….days and gradually solidify and Stool occult blood may be positive for ………….days.

Answer 17

1-3 days,7-10 days

Question 18

HEMATOCHEZIA definition

Answer 18

the presence of fresh red or dark red-cherry rot stool.

Question 19

what is the difference between melena and hematochezia?

Answer 19

Melena is the passage of black, tarry stools. Hematochezia is the passage of fresh blood per anus, usually in or with stools.

Question 20

HEMATOCHEZIA generally indicates ……………GI bleeding

Answer 20

-lower GI bleeding(distal to the leg of Treitz)
-(In case of severe upper GI bleeding and/or rapid
bowel passage, upper GI bleeding may also occur).

Question 21

in HEMATOCHEZIA as the bleeding focus shifts distally , the color of the blood becomes …………….(darker/lighter)

Answer 21

lighter

Question 22

what are the symptoms of patient with loss of less than 20% blood loss(<1000) in hematochezia

Answer 22

◦ Hardly any clinical signs.
◦ May be tachycardia after exertion.

Question 23

what are the symptoms of patient with 20-25% (1000-1250 ml) blood loss in hematochezia

Answer 23

◦ HR> 100(tachycardia)
◦ Blood pressure is normal or slightly low when lying down.
◦ When sitting, there is a decrease in systolic BP of at least 10 mmHg and an increase in pulse rate of at least 20/min (Tilt test).

Question 24

what are the symptoms of patient with 25-35%(1250-1800 ml) blood loss in hematochezia

Answer 24

Hypotension in the lying position.
◦ HR> 120
◦ Oliguria.

Question 25

what are the symptoms of patient with more than 35%(>1800 ml) blood loss in hematochezia

Answer 25

◦ Deep hypotension ◦ HR> 140 ◦ Shock is present.

Question 26

if we have a pt with GI bleeding without tachycardia ,what could be the reason of no tachycardia?

Answer 26

maybe he or she has a history of using beta-blocker

Question 27

in acute GI bleeding ,erythrocytes are............

Answer 27

normocytic (not enough red cells)

Question 28

in chronic GI bleeding ,erythrocytes are..................

Answer 28

microcytic(smaller than normal becuz of not enough hb

Question 29

for upper GI bleeding we do .............

Answer 29

early endoscopy (within 24hr) If no pathology is found, colonoscopy is performed after bowel cleaning (upper bleeding should also be excluded in lower GI bleeding).

Question 30

for lower GI bleeding we do................

Answer 30

rectosigmoidoscopy (If no pathology is found, colonoscopy is performed after bowel cleaning (upper bleeding should also be excluded in lower GI bleeding).

Question 31

when we use angiography in GI bleeding

Answer 31

indicates active bleeding over 0.5 ml/min

Question 32

when we can take image in GI bleeding with scintigraphy?

Answer 32

for 36 hrs in bleeding above 0.5 ml/min

Question 33

what are the clinic of upper GI bleeding

Answer 33

 Hematemesis  Melena  Hematochezia (rare)!!!  Bleeding signs  Sometimes the first and only sign may be fainting on the toilet.  Angina, MI

Question 34

what are the priorities treatment of upper GI bleeding?

Answer 34

-vascular access from both arms -IV volume replacement -antisecretory therapy (PPI)(only upper GIS bleeding) -monitorization (BP,HR,Respiration rate) -FM,History,diagnostic procedures -nasogastric application-decompression -endoscopic examination

Question 35

PPI dosage in upper GIS bleeding

Answer 35

pantoprazol/esomeprazol 80 mg loading dose -8 mg/hr infusion

Question 36

who are the risky patients fo upper GIS bleeding

Answer 36

◦ Over 60 years old ◦ Whose first complaint is hematemesis ◦ With additional disease ◦ With hypotension, tachycardia and Tilt test (+) ◦ In shock ◦ Recurrent bleeding in the first 48 hours ◦ Those who describe hematochezia ◦ Variceal bleeding ◦ Requiring transfusion ◦ Those with evidence of active or new bleeding on endoscopy ◦ Those of the hard-to-find blood group