Term
| T/F: bleeds outside hospital have better outcomes than bleeds inside hospital |
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Definition
| T: because pts that bleed in hospital are sicker |
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Term
| T/F: Outcome of GI bleeding does not depend on comorbid diseases |
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Definition
F - 0, 1, 2, 3 comorbidities => inc mortality
o Mortality 3.5-7% for UBIB, LGIB 3.6% (upper > lower) |
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Term
| T/F: endoscopy is only reserved for very few special cases |
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Definition
F: o Most pts get scoped with UGIB within 24hrs
20-35% include endoscopic therapy |
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Term
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Definition
o Over: can see it
o Occult: hidden
o Obscure: bleeding, but don’t know where it’s coming from |
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Term
| T/F: If a patient has orthostatis <90, you should immediately start transfusing blood. |
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Definition
F: Start IV fluids first...but know that
ORTHOSTASIS < 90 systolic: worse morbidity and mortality – KNOW THIS!
• Rule: Hypotensive bleeds (upper or lower) define outcome |
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Term
| What are the cut offs for Hgb/Hct in young and infirm px? |
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Definition
Hgb/Hct
• Young pts: approximately 7/20
• old/infirm….approx 10/30 |
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Term
| T/F: Pts with bright red blood in the stools could have an upper GI bleed. |
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Definition
| T: Especially if there's a brisk bleed in duodenum and lavage comes back negative for upper GI bleed. Upper source must be found so it can be treated with upper endoscopy. |
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Term
| What meds are risk factors for bleeding? |
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Definition
| warfarin, NSAIDs, antiplatelets |
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Term
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Definition
Upper:
• Melena, burgundy stool, hematemesis
• May have elevated BUN, but may be due to dehydration
• Massive UGIB may have red blood from below |
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Term
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Definition
Lower: hematochezia
• Remember: most LGIB of diverticular origin stop on their own |
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Term
| If you suspect an esophageal source of bleeding, what can it be due to? |
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Definition
| esophagitis/ulcer (reflux, infectious, pill), varices (portal htn,cirrhosis), cancer, Mallory Weiss tear (from retching) |
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Term
| If you suspect a stomach source of bleeding, what can it be due to? |
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Definition
| ulcer/erosion (H. pylori, NSAIDs/aspirin), Mallory Weiss (could also be in cardia), Dieulafoy lesion (artery that never tapers), varices, cancer, AVMs/GAVE |
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Term
| If you suspect a duodenal source of bleeding, what can it be due to? |
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Definition
ulcer/erosion, angiodysplasia, dieulafoy, cancer (ampullary, duodenal), less common (hemobilia, hemosuccus pancreaticus, aortoenteric fistula)
o Note: cancer rarely presents with acute upper GI bleed |
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Term
| If you suspect a small bowel source of bleeding, what can it be due to? |
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Definition
| ANGIODYSPLASIA/AVM (hemodynamically stable, melena and either renal insufficiency, heart valve disease, portal HTN or HHT), Dieulafoy (recurrent, obscure bleeding), NSAIDs/ASA, Crohn’s, hemangioma, cancer, Meckel’s |
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Term
| If you suspect a colonic source of bleeding, what can it be due to? |
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Definition
| diverticulosis (brisk bleed, painless, older pts), angiodysplasia (slow ooze), hemorrhoids (can be brisk, BRB on TP, unlikely if hypotensive), fissure (pair with defecation), ischemia, infectious, inflammatory, radiation, cancer, NSAIDs/ASA, rectal ulcer, portal HTN |
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Term
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Definition
| is a medical condition characterized by a large tortuous arteriole in the stomach wall that erodes and bleeds. It can cause gastric hemorrhage[1] but is relatively uncommon. It is thought to cause less than 5% of all gastrointestinal bleeds in adults. |
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Term
| Mallory–Weiss syndrome or gastro-esophageal laceration syndrome |
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Definition
| refers to bleeding from tears (a Mallory-Weiss tear) in the mucosa at the junction of the stomach and esophagus, usually caused by severe retching, coughing, or vomiting. |
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Term
| T/F: volume contraction means small vessel bleeding (ulcers < diverticuli < AVM) |
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Definition
| F: volume contraction means large vessel bleeding (ulcers > diverticuli > AVM) |
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Term
| When and why would you put a nasogastric tube into a GI bleeding px? |
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Definition
• Reasonable when suspected upper source or if unclear
• Can determine if source is stomach (and maybe duodenum)
• Can determine if bleeding is active
• Can give clue to rate of bleeding
• Can irrigate and clean stomach prior to endoscopy |
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Term
| T/F: Hemoccult are a mainstay of determining GI bleeds |
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Definition
F: • Hemoccult cards are designed for colon cancer screening
• For GI bleeds, rely on whether you see blood, NOT on hemoccult card
• Hemoccult positivity ≠ GI bleed |
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Term
| Describe the steps of endoscopy: |
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Definition
• Injection: epinephrine, sclerosant (sodium morrhuate) – varices, glue
• Thermal: APC (argon plasma coagulation), bipolar or monopolar cautery
• Banding
• Clipping
• Segstaken-Blakemore balloon - varices |
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Term
| What drugs can we give for acute GI bleeds? |
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Definition
| PPI (good for acute GI bleed from ulcer), H2RA, sandostatin |
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Term
| During the endoscopy you see stigmata from ulcers. What is this and how do you prevent this? |
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Definition
Could be due to: spurting arterial bleeding (85-100% rebleed), non-bleeding visible vessel, adherent clot, others, no stigmata (i.e. no visible signs of bleeding)
Prevent with: PPI, beta-blocker, manage risk (NSAIDs, ASA, warfarin, clopidogrel)
o Ulcers: medical therapy |
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Term
| You see a red wale, white spot, clot on endoscopy...what is this and how to treat? |
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Definition
Varices...
beta-blockade + banding |
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Term
| . If pt vomited without blood first, then started bleeding...what is it? |
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Definition
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