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29 Cards in this Set
- Front
- Back
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What are the initial goals to a GI bleed |
1. Stabilize pt 2. Determine if upper or lower gI bleed 3. Determine how severe it is 4. Initial supportive treatment 5. Further evaluation |
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What structure do you use to determine if it is an upper or lower GI bleed |
Ligament of Treitz |
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Is the stool colour a way to diagnose a GI bleed |
No, it is only suggestive |
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How can a nasogastric tube confirm of deny the presence of a bleed |
If you insert an NG tube and there is blood it confirms upper GI bleed
If no blood it is either a lower GI bleed or closed pylorus |
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For an upper GI bleed 1. What does hematemesis look like 2. What is the poop like 3. What is it more likely to cause |
1. Fresh blood, coffee grounds 2. Melena 3. Hemodynamic instability
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For a lower GI bleed 1. What is its relation to the ligament of treitz 2. What colour is the poop if the bleed is in the left colon, right colon, cecum |
1. Distal 2. Left colon = bright red Right colon = dark, maroon Cecum = melena |
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What is the most common cause of upper GI bleeds |
Peptic ulcer disease |
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What are some of the causes of peptic ulcer disease (PUD) |
1. H.pylori 2. NSAIDs 3. Medical stress 4. Gastric acid (Zollinger Ellison Syndrome) |
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What are some of the symptoms of PUD |
1. Dyspepsia |
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What is the treatment of PUD |
1. PPI/Abx 2. Endoscopy 3. Surgery |
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1. What causes Esophageal Varices 2. What percentage stop spontaneously
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1.Portal hypertension (cirrhosis, splenic vein obstruction 2. 50%
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What is the treatment for esophageal varices |
1. Banding 2. Octreotide (somatostatin analog = reduces splanchnic blood flow) 3. TIPS (transjugular intrahepatic portosystemic shunt) 4. Prevention (beta blocker, transplantation) |
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1. What causes esophagitis |
1. Peptic Reflux 2. Infection (herpes zoster, condida) 3. Meds (Alendronat (bisphosphonate), tetracylcin, NSAID) 4. Corrosive (button battery) |
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1. What are the symptoms of esophagitis 2. What is the treatment |
1. Odonphagia, retrosternal pain 2. Treat underlying cause |
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What are some other causes of Upper GI bleed |
1. Mallory- Weiss tear (from repeated vomiting) 2. Malignancy 3. Angiodysplasia (abnormal blood vessels form and bleed) 4. Aorto-enteric fistula (connection between aorta and gut from AAA repair) 5. Dieulafoy's lesion (congenital arteriole aneurysm in gastric mucosa) |
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What are 5 causes of lower GI bleeds |
1. Diverticula 2. Andiodysplasia 3. Colitis 4. Malignancy 5. Hemorrhoids/Fissure (most common) |
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1. What is a diverticulum 2. What is diverticulosis 3. What is diverticular disease 4. Risk factors 5. Symptoms 6. Amount of bleeding |
1. Sac like protrusion of the colon wall 2. Presence of diverticula 3. Diverticulosis, diverticulitis (inflammation) 4. Low fibre, constipation, obesity, age 5. Usually painless 6. Massive bleeding |
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1. What is angiodysplasia 2. When do incidences increase |
1. Dilated tortuous submucosal vessels 2. Increases with age |
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What is the most common infectious colitis |
Shigella |
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What causes ischemic colitis |
Heart failure arrythmia A fib Hypotension |
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What are the two types of inflammatory bow diease |
Ulcerative Colitis Crohns |
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What are some other things that can cause lower GI bleeds |
1. Polyps 2. Hemorrhoids 3. Fissure 4. Radiation enteritis (acute 6 weeks, chronic 9-14 months)
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How do you fix GI bleeds |
1. ABC 2. NPO (don't let them eat) 3. 2 large bore IVs 4. +/- NG tube 5. Labs: G+M, CBC, chem, LFT, INR/PTT 6. Fluid resuscitation (NS/Ringers lactate, packed RBC (Hgb 70-90), fresh frozen plasma (INR >1.5) platelets (PLT < 50,000) 7. Prevent hypothermia (give warm IV) |
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What is the treatment if you have an upper GI bleed |
1. PPI (Pantoprazole) 2. Octrotide if suspect varices 3. Ballon Tamponade (Sengstaken, Blakemore, Minnesota tube) |
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What are the RED Flags |
1. > 50 years old 2. Upper GI: Melena, dark blood, postural changes 3. Malignancy (constitutional symptoms: fever, night sweats, weight loss) anemia, change in stool 4. FHx of malignancy (colon)
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What do you do if the Bright Red Blood Per Rectum (BRBPR):
1. < 40 year old no red flags and potential source for bleed 2. > 50 years old 3. 40-50 years old no red flags, actively bleeding source identified |
1. No further investigations 2. Colonoscopy (unless good quality scope in last 2-3 years) 3. No further investigations |
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What is the primary tool used for investigation |
1. Endoscopy (colonoscopy/gastroscopy)
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What is the prep for a colonoscopy |
4 L Golytely or pico salix |
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What can be used to tag RBC in occult bleeding |
Technicium (AV malformations which aren't visible on scope) |
