UGIB Flashcards
(26 cards)
Upper GI bleeding is any GI bleeding originating where?
proximal to the ligament of Treitz
_______________which includes gastric, duodenal, esophageal, and stomal ulcers, is still considered the most common cause of upper GI bleeding
peptic ulcer disease
_________________is the cause of upper GI bleeding in cirrhotics 59% of the time, followed by____________ in 16% of cases
Variceal bleeding
peptic ulcer disease
_____________________is bleeding secondary to a longitudinal mucosal tear at the gastroesophageal junction
Mallory-Weiss syndrome
Mallory-Weiss syndrome classic history is
repeated vomiting followed by bright red hematemesis
True or false
Mallory-Weiss syndrome can be associated with alcoholic binge drinking, DKA, or chemotherapy administration. As well as Valsalva maneuver, such as from coughing or seizures
True
These are arteries of the GI tract that protrude through the submucosa.
Dieulafoy lesions
Dieulafoy lesions are most commonly found in the___________________ but may be found anywhere in the GI tract; 80% to 95% are found within __________________
lesser curvature of the stomach
6cm of the gastroesophageal junction
Classically, this presents as a self-limited “herald” bleed with hematemesis or hematochezia, which precedes massive hem- orrhage and exsanguination.
An aortoenteric fistula secondary to a preexisting aortic graft
This is an unusual but important cause of bleed
True or false
Bright red or maroon rectal bleeding unexpectedly originates from upper GI sources about 14% of the time
True
is the most reliable way to diagnose upper GI bleeding in the ED
Visual inspection of the vomitus for a bloody, maroon, or coffee- ground appearance
In patients with significant bleeding, the single most important laboratory test is _____________
obtain blood for type and cross-match
in case transfusion is needed
A BUN:creatinine ratio of _______ suggests an upper GI source of bleeding
≥30
Barium contrast studies are contraindicated because barium may
hinder subsequent endoscopy or angiography
In cases where traditional endoscopy is unavailable or endoscopic visualization is unable to find the source, consider _______________ or ______________
tagged red-cell scintigraphy
visceral angiography
True or false
tagged red-cell scintigraphy or visceral angiography, demonstrate the source ONLY in cases of active bleeding
True
Both help localize the source of bleeding to determine whether medical or surgical management is optimal
What can cause false-negative results ?
Intermittent bleeding, pyloric spasm, or edema preventing reflux of duodenal blood
Pre-endoscopic predictors of higher risk include:
advanced age
comorbidities
red hematemesis
hematochezia
red blood on nasogastric aspirate
hemodynamic instability
abnormal laboratory studies
prior variceal banding
clamping or cauterization of an ulcer bed
transjugular intrahepatic portosystemic shunt procedure
A restrictive transfusion threshold using hemoglobin concentrations of__________ in most patients and __________ in older patients with comorbidities who are not tolerating the acute anemia is recommended.
<7 grams/dL
<9 grams/dL
An INR______ is a significant predictor of mortality in patients with an upper GI bleed who are receiving anticoagulants.
≥1.5
International consensus guidelines recommend reversal of coagulopathy for upper GI bleed patients who have an elevated INR or platelet counts ________
<50,000/μL
Octreotide mechanism of action
Octreotide is a long-acting analogue of somatostatin that elicits several actions in patients with upper GI bleeding. It inhibits the secretion of gastric acid, reduces blood flow to the gastroduodenal mucosa, and causes splanchnic vasoconstriction
Why do we give antibiotics in bleeding cirrhotic patients?
Patients with cirrhosis have an impaired immune system and have an increased risk of gut bacterial translocation during an acute bleeding episode. Prophylactic antibiotics (e.g., ciprofloxacin 400 milligrams IV or ceftriaxone 1 gram IV) reduce infectious complications, rebleeding, days of hospitalization, mortality from bacterial infections, and all-cause mortality
What are examples of promotility agents? Function?
Erythromycin and metoclopramide are examples of promotility agents used to enhance endoscopic visualization. Consider administration if the patient is undergoing endoscopy in the ED and the patient is sus- pected to have large amounts of blood in the upper GI tract.
