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Flashcards in Upper GI Bleed FE Deck (13):

What is an Upper GI Bleed?

The presence of bleeding in the esophagus, stomach or duodenum.


What is the focus for Upper GI Bleeding?

URGENT: Find the source!
Site and type of blood vessel. (capillary? artery? vein?)
(in meantime, NPO and IV fluids/transfusion.)


What are 5 causes of Upper GI bleeding?

1. Gastritis
2. Ulcer
3. Cancer
4. Meds
5. Other (trauma, etc)


What are two types of Upper GI bleeding?

1. Acute
2. Chronic


What is Acute Upper GI Bleeding?

Sudden or massive onset (with previous normal hgb. Feel faint, low BP, hypovolemic, nauseated, etc.)


What is Chronic Upper GI Bleeding?

Insidious bleeding that is difficult to detect. (less s/sx because body is compensating.
(May occur intermittently)


Disorders that involve bleeding--what do we want to do?

Provide primary hemodynamic stabilization to avoid hypovolemic shock.


What are four diagnostic tests for Upper GI Bleeding?

1. Labs --frequent H+H (q4-6 hours) and monitoring trends
2. Upper Endoscopy (may need to be emergent)
3. Guaiac stool for presence of occult blood
4. Frequent VS to monitor trends (based on condition)


What are 6 clinical manifestations of Upper GI Bleed?

1. Fatigue, low energy, (esp with chronic bleed)
2. Pain
3. Dyspepsia (indigestion)
4. Hematemesis (coffee ground, red)
5. Melena (dark, tarry stool)


If pt has a sudden or massive upper GI bleed, what might be pt s/sx?

Signs of shock:
1. Anxiety
2. Restlessness
3. Change in LOC
4. Tachycardia
5. Dyspnea
6. Tachypnea
7. Cool, clammy skin (conservation of blood leads to less warmth)
8. Nausea


What are five tx for Upper GI bleed?

1. Monitor for s/sx of hypovolemia/shock or perforation
2. Frequent VS, H+H, LOC and O2 status
3. Multiple large bore IVs (18g or central line)
4. NG tube
5. Fluid replacement (crystalloid>>blood transfusion if needed)
6. Medications
7. Endoscopy
8. Surgery if unable to control bleeding


What are some medications that can help with Upper GI bleeds?

1. PPI, H2 blocker (IVP or infusion)
2. Octreotide (Sandostatin) IV infusion (decreases blood flow to area, decreases production of hydrochloric acid)
3. Chronic bleed will need PPI, Sucralfate, Iron supplement


What are three types of endoscopy treatments for upper GI bleed?

1. Thermal probe (cauterize bleeding)
2. Laser therapy
3. Sclerotherapy (injecting medication like saline, dextrose or epinephrine into vein causing it to get irritated, collapse and stick together-providing hemostasis.)