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Flashcards in Upper GI Bleeding Deck (28)
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1

Etiology and patho

Most serious loss of blood from UGI characterized by sudden onset
Insidious occult bleeding can also be a major problem
Severity depends on bleeding origin (venous, capillary, arterial)

2

Hematemesis

Obvious bleeding
Bloody vomitus
Appears fresh, bright red blood or "coffee grounds"

3

Melena

Obvious bleeding
Black, tarry stools
Caused by digestions of blood in GI tract
Black appearance due to iron
The longer the passage of blood through intestines, the darker the stool color, caused by breakdown of Hgb and release of iron
Cause of bleeding is not always easy to determine

4

Occult bleeding

Small amounts of blood in gastric secretions, vomitus, or stools
Undetectable by appearance
Detectable by guaiac test

5

Bleeding from arterial source...

Profuse, blood is bright red
*Bright red blood indicates the it has not been in contact w/ stomach acid secretions

6

Coffee ground vomitus reveals...

Blood has been in stomach for some times
blood has been changed by gastric secretions

7

Massive upper GI hemorrhage...

Loss of more than 1500 mL of blood
OR
Loss of 25% of intravascular blood volume

8

Common causes of UGI bleeding

Esophageal origin
Stomach and duodenal origin
Drug-induced origin
Systemic disease region

9

Esophageal origin causes of bleeding

Chronic esophagitis
-GERD
-Mucosa-irritating drugs (aspirin, NSAIDs, corticosteroids)
-Alcohol
-Cigarettes

10

Stomach and duodenal origin causes of bleeding

Peptic ulcer disease
-Bleeding ulcers account for 40% of cases of UGI bleeding
-R/t H. pylori or drug use (NSAIDs)
Gastric cancer
Hemorrhagic gastritis
Polyps
Stress-related mucosal disease (SRMD)
-Also called physiologic stress ulcers
-Occurs in pts w/ severe burns or trauma, or after major surgery

11

Endoscopy

Primary tool for diagnosing source of bleeding
Before performing:
-Lavage may be needed for clearer view
-NG or orogastric tube placed, and room temp water or saline used
-Do not advance tube against resistance!

12

Lab studies

CBC
BUN measurement
Serum electrolyte measuremetns
PT, PTT
Liver enzyme measurements

13

Blood replacement

Hbg and Hct provide baseline for further treatment
Initial Hct may be normal and may not reflect loss until 4-6 hrs after fluid replacement
-Initially, losses of plasma and RBC are equal

14

Endoscopic Hemostasis Therapy

Goal: to achieve coagulation or thrombosis in bleeding artery
-useful for gastritis, Mallory-Weiss tear, esophageal and gastric varices, bleeding peptic ulcers, polyps

15

Thermal (Heat) Probe

Coagulates tissue by directly applying heat to site
*Endoscopic hemostasis

16

Endoscopic hemostasis techniques

Thermal probe
Electrocoagulation probe (mulltipolar and bipolar)
Argon plasma coagulation (APC)
Neodymium yttrium \-aluminum-garnet (Nd-YAG) laser

17

Drug therapy

During acute phase, used to:
- decrease bleeding
- decrease HCl acid secretion
- Neutralize HCl acid that is
Injection therapy w/ epinephrine during endoscopy for acute hemostasis

18

Drug therapy for bleeding due to ulceration

Epinephrine
-Produces tissue edema -> pressure on bleeding source
Usually combined w/ other therapies

19

Acid reducers drug therapy

Acidic environment can alter platelet function and clot stabilization
Histamine-2 receptor (H2R) blockers
-Inhibit action of histamine at H2 receptors and decrease HCl acid secretion
-Cimetidine
-Ranitidine

20

Proton Pump Inhibitors (PPIs)

Acid reducer
Suppresses gastric secretion by inhibiting H+, K+, ATPase enzyme system
Inhibits gastric acid pump
-Pantoprazole
Esomeprazole
*No proven ability to control active bleeding

21

Somatostatin or Somatostatin analog octreotide

Drug therapy
Used for upper GI bleeding
Reduces blood flow to the GI organs and acid secretion
Given IV boluses for 3-7 days after onset of bleeding

22

S/Sx of shock

Low BP
Rapid, weak pulse
Increased thirst
Cold, clammy skin
Restlessness
Monitor VS q 15-30 min and inform HCP of any significant changes

23

Nursing dx

Decreased cardiac output
Deficient fluid volume
Ineffective peripheral tissue perfusion
Anxiety

24

Health promotion

Pt w/ hx of chronic gastritis or peptic ulcer disease is at high risk
Pt who has had one major bleeding episode is more likely to have another
Pt w/ cirrhosis or previous UGI bleed is also at high risk

25

Patient teaching

Disease process and drug therapy
Avoidance of gastric irritants
-alcohol
-smoking
-stress-inducing situations
Take only prescribed medications
Methods of testing vomitus/stools for occult blood
Potential adverse effects related to GI bleeding
Prompt treatment of upper respiratory infection in pt w/ esophageal varices
If aspirin must be prescribed, enteric-coated tablets can be substituted for regular tablets
Taking meds w/ meals or snacks lessens potential irritating effects

26

Acute interventions

IV maintenance
Accurate I/O record
-Urine output hourly
-At least 0.5 mL/kg/hr indicates adequate renal perfusion
-urine specific gravity should be measured (normal: 1.005-1.025)

27

If NG tube is inserted

Keep in proper position
Observe for aspirate blood
Effectiveness of gastric lavage is questionable

28

Hemorrhage that is result of chronic alcohol abuse

Closely observe for delirium tremens
-agitation
-uncontrolled shaking
-sweating
-vivid hallucinations