Lecture 10: GI Bleeding Flashcards Preview

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Flashcards in Lecture 10: GI Bleeding Deck (40):
1

What to check to see if a GI bleed is an emergency?

Vitals (hypotension/tachycardia) = hypovolemia

2

Why do patients with a GI bleed get an elevated BUN

Hypovolemia and absorbed blood protein

3

NG lavage tube...reliable to test for bleeds?

Nope: can get false negatives and positives

4

History suggesting GI bleed/causes (7)

Aspirin/NSAID, ulcer disease, liver disease (varices), preceding retching (MW tear), GERD (esophagitis), aorta-enteric fistula (aortic aneurysm surgery), cancer

5

Two types of GI bleeds

Overt: hematemesis, melena, hematochezia; Occult: microscopic blood in stool over weeks to months

6

Occult bleeding leads to..

Anemia and iron deficiency

7

What is hematochezia

Red/maroon blood in stool associated with frequent BM

8

Things that suggest upper bleed

Hematemasis, coffee grounds, melena

9

Thing that suggests lower bleed

Hematochezia (or MASSIVE upper bleed)

10

Why do we scope?

Diagnose, treat, prognosis

11

Peptic ulcer accounts for % of upper GI bleeds; etiology, % stop spontaneously

50%; H pylori or NSAIDs; 80%

12

GI Bleed: what do we do?

IV fluid, IV PPI, urget endoscopy (dx, tx, prognosis), surgery (failure of medical therapy), always look for H pylori

13

Once again, what do we always do with gastric ulcers?

Look for H pylori

14

Gastritis: % of upper GI bleeds, life threatening? Etiology?

15%, usually not life threatening, NSAIDs, alcoholism, stress gastritis (serious stress), inhibit acid and avoid NSAIDs

15

Neoplasm: what kind of bleeding?

Chronic bleeding (occult)

16

Two esophageal causes of GI bleeds

Mallory Weiss tear and esophageal varices

17

Dieulafoy lesion

Large caliber artery in stomach with significant bleeding, hard to find

18

GAVE

Watermelon stomach, dilated mucosal vessels

19

Aorto-Enteric fistula. Common presentation?

Massive bleeding in pt with prior aortic graft that erodes into duodenum; herald bleed (massive bleed that then stops)

20

Cameron lesion. Type of bleeding?

Erosions or ulcerations that occur within a hiatal hernia; typically occult

21

Endoscopic therapy techniques

Injection (epi, ST but helps you visualize area), hemostatic therapy (cauterizing), band ligation (common for esophageal varices), clips

22

Lower GI bleeding presents with what? Common course?

Hematochezia, frequently stops spontaneously (intermittent)

23

T/F: Lower GI bleeding is typically chronic

True

24

Common causes of lower GI bleeding (4)

Hemorrhoid (painless, blood on tissue), anal fissure (pain during stool passage), colitis (urgency, tenesmus, pain, diarrhea), polyp/cancer (blood mixed with stool)

25

Two causes of acute hemodynamically significant lower GI bleeds

1. Diverticulosis and 2. Arteriovenous malformations (AVMs)

26

Most common causes of hemorrhoids (2)

Pregnancy and constipation

27

Anal fissure presentaton, tx

Red blood with BM, tearing/burning pain, blood in toilet bowel, tx = topical medications

28

T/F: It's always easy to find bleeding diverticulum

False: pts often have more than one diverticulum and the bleeding can be sporadic

29

Colitis: presentation

Blood/cramping either acute (ischemia, infectious) or chronic (IBD, Crohn's)

30

Can colon polyp's bleed? What percent of polyps and cancer bleeds are associated with acute lower GI bleeds?

Yes (also after polyp removal); 5%

31

How to evaluate lower GI bleeding?

Endoscopy (colonoscopy) or nuclear scan

32

Describe nuclear scan

Labeled RBC scan, and can be repeated within 24 hours if bleeding begins again

33

Describe angiogram

Catheter in femoral artery with contrast to see where the leak is, then you can give therapy to help bleeding (however, requires active bleeding and is invasive w/ complications)

34

What % of bleeding is not identified by upper or lower endoscopy? What is it called?

5%, "obscure" GI bleeding

35

Causes of obscure GI bleeding

Small intestinal: Vascular (AVM), neoplastic, inflammatory diseases, Meckel's diverticulum; biliary; pancreatic

36

Why does Meckel's diverticulum produce bleeding? Painful?

Heterotopic gastric mucosa --> acid --> ulceration --> bleeding; non-painful bleeding

37

How to dx Meckel's?

Meckel's scan (nuclear) that looks for parietal cells

38

Patent profile for Meckel's

Young males, obscure bleeding

39

What is a push entroscopy? What is a surgical option? What is a non-invasive option?

Endoscopy of the small intestine, can reach the mid jejunum (4 ft); intra-operative endoscopy (very invasive); capsule endoscopy (camera)

40

If you find something with a capsule endoscopy, what do you do next?

Double-balloon enteroscopy