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41 Cards in this Set
- Front
- Back
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Who more commonly gets upper GI bleeds: men or women?
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Men
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What's more common: upper or lower GI bleeds?
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Upper
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What's the strategy for a patient with a GI bleed?
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1. LOOKATEM
2. Start resucitation 3. Amt. of blood loss 4. Upper/lower source 5. Stop the bleeding/confirm source 6. Prevent future bleeding |
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What are things you should note about the patients appearance when you see them come in for a GI bleed?
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Hydration status
Pallor: more pale, more blood lost Distress Mentation: decreased, very worrisome |
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What vitals should you pay special attention if someone comes in with a GI bleed?
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Heart rate: tachycardic if blood lost
BP: see if orthostatic |
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What are labs that you should get for someone who comes in with a GI bleed?
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Stigmata of cirrhosis
Visible blood in rectum Coagulation studies (PT/INR) Platelts Renal function |
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What are the 3 O's of bleeding?
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Overt: visible blood
occult: not visible except to hemooccult testing Obscure: don't know where it comes from |
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What are the principles of resucitation for someone with a GI bleed?
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IV fluids first: you need to get access
GET BLOOD TYPE CBC O2 If bleeding is significant, start a transfusion The question: ICU or not? |
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What is an indicator of lots of blood loss from the GI tract?
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Bright blood in the stool
Frequent passage of blood Hypotension/tachycardia |
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What is an indicator that small amounts of blood has been lost from the GI tract?
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Brown stool with no visible blood
Infrequent bowel movements Hemodynamically stable No recent bleeding |
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What is the effect of blood on bowel movements?
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It makes them happen!
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What should you target for hematocrit in someone who's young? Old/infirm?
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Young: 7/20
Old/infirm: 10/30 |
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What are findings in an upper GI bleed?
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Melena, hematemesis
Elevated BUN If a MASSIVE bleed, red blood per rectum |
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What are findings in a lower GI bleed?
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Hematochezia: red blood per rectum
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What are some elements of history that you need to ask about in a GI bleed?
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Bleeding history:
-Nose bleeds -Episodic GI bleeding Medical history: -Prior PUD -Cancer -Cirrhosis -Coagulopathy Recent surgery Meds: -NSAIDS -Plavix -Coumadin Alcohol |
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What are some categories of GI bleeding?
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Vriceal vs. non-variceal
Location: -Esophagus -Stomach -Duodenum -Small bowel -Colon |
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What's the most common cause of bleeding from the esophagus?
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Varices due to portal hypertension/cirrhosis
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Other than varices, what are some other causes of bleeding from the esophagus?
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Esophagitis/ulcer: reflex, infectious, pill
Cancer Mallory Weiss tear |
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What happens in a Mallory Weiss tear?
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Mechanical tear in distal esophagus due to the stomach being pushed up into the esophagus while vomiting. Mechanical forces then cause a tear in the esophagus
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What's the most common cause of bleeding in the stomach?
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PUD
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What are the most common cause of PUD?
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H. pylori
NSAIDs/Asprin |
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Other than PUD, what are common causes of bleeding from the stomch?
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Mallory Weiss tear
Dieulafoy lesion Varices Cancer AVMs/GAVE |
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What is a Dieulafoy lesion? Where does it happen/
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Small arterial branch that comes to the surface of the GI tract
Rare. |
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What are common causes of bleeding from the duodenum?
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Ulcer/erosion
Angiodysplasia Dieulafoy Cancer: ampullary, duodenal |
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What are some less common causes of bleeding from the duodenum?
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Hemobilia (blood from the liver)
Hemosuccus pancreatitis (pseudoaneurysm) Aortoenteric fistula |
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What are the two most common causes of UGIB?
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PUD
Varices |
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Typically, do you see bleeding from the small bowel?
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No.
It's not at the top of your list |
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What are causes of bleeding from the small bowel?
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Angiodysplasia
Dieulafoy NSAIDs/Asprin Crohn's Hemangioma Cancer Meckel's diverticulum |
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What are causes of brisk bleed from the colon?
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Diverticulitis
Hemorrhoids |
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What causes a slow bleed from the colon?
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Angiodysplasia
Cancer |
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What is a cause of bleeding that also causes pain with defecation?
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Fissures
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How many people stop bleeding spontaneously?
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80%
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What are signs that someone is still bleeding?
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Visible blood
Recent BM or hematemesis Bright blood (active) vs. coffee grounds (stopped) NG tube |
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How do you use an NG tube to see if bleeding is occurring?
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Suction the stuff from the stomach; see if there's blodo there.
If there is, it's a clue that there's an upper GI bleed |
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Should you use a hemoccult card for a GI bleed?
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NO!
They're JUST for colon cancer screening! |
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How do you go about stopping bleeding by endoscopy?
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Injection
Thermal: fry it Ligation: plug it |
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What can you inject to stop bleeding during endoscopy?
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Epinephrine
Sclerosant |
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What are some other ways to stop bleeding other than endoscopy?
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IR
Surgery: oversew Drugs: PPIs, H2RA; sandostatin |
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What are bad stigmata that give a poor prognosis via endoscopy in PUD?
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Spurting arterial bleeding (85-100% rebleed)
Non-bleeding visible vessel (18-55%) Adherent clot (24-41%) |
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What are some bad stigmata via endoscopy for varices?
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Red wale
White spot Clots |
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What are some drugs that can be given to prevent GI bleeds?
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PPIs
Beta blockers Manage the risk by carefully thinking about the different anti-coagulent drugs: (NSAIDs, ASA, coumatdin, etc.) |
