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31 Cards in this Set
- Front
- Back
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when a pt presents with GI bleed you must make sure to place a
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Large Bore Central line
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after you place a central line make sure you
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give saline and packed RBC
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Ongoing bleeding
Systolic B.P.<100mm Hg Prothrombin time > 1- 2 x control Altered mental status Unstable comorbid disease (requiring ICU admission) are risks that if... |
If any one criteria is present a 3 X increase in the risk of further hemorrhage, surgery, or death
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Hematochezia normally suggests a colonic source, but it can be upper GI if...
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if the magnitude is significant, even upper GI hemorrhage may produce hematochezia
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read:
evaluation of GI bleed-- |
Nasogastric Aspiration & Lavage (Immediate)
Esophagogastroduodenoscopy EGD (Early >90% sensitivity) Endoscopy should be performed immediately after endotracheal intubation (if indicated), hemodynamic stabilization, and adequate monitoring in an ICU setting have been achieved. Technetium 99m labeled RBC Scan (ITRBC) Angiography |
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what is the method of choice for controlling active ulcer hemorrhage?
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Endoscopic controlled hemostasis
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most common cause of GI bleed in child 4-18
**in red |
Meckel's diverticulum
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lower GI bleed is most often due to
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diverticular disease
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ACTIVE DUODENAL ULCER MAY PRESENT AS A LOWER G.I. BLEED ! what do you do as the first diagnostic step?
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INSERT A NASOGASTRIC TUBE AS THE FIRST DIAGNOSTIC STEP !
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Meckel's Diverticulum rules of two
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2 FEET PROXIMAL TO ILEOCECAL VALVE
OCCURS IN 2% OF POPULATION 2 INCHES LONG TWO COMMON TYPES OF TISSUE (GASTRIC OR PANCREATIC) PRESENTS SYMPTOMATICALLY IN 2 WAYS HEMORRHAGE OR OBSTRUCTION CLINICALLY EVIDENT WITHIN FIRST 2 DECADES, USUALLY WITHIN FIRST 2 YEARS |
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general tx for diverticular bleed?
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75-90% of patients will stop with supportive therapy only
Localize with Technetium 99 Red Blood Cell Tagged (ITRBC) will show bleeding at a rate of 0.1 ml/min or with Arteriography will show bleeding at a rate of 1.5 ml/min ---this is when you do surgery |
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Angiodysplasia is what kind of bleed?
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Bleeding is venous, may be less severe than diverticular bleed
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Carcinoma of the colon is the most common cause of mild to moderate
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lower G.I. bleeding
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GI tumors are second only to PUD as a cause of occult bleeding leading to iron deficiency anemia
read this |
Colorectal cancer is currently the most common source of occult bleeding from GI tract malignancies
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black stools show you what
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blood uper GI bleeding, tarry and sticky with foul smell
non bloody think pepto-bismol |
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NSAIDs can give rise to what?
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gastritis or precipitate bleeding from ulcers (misoprostol stops this! throwback!)
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what causes the black stools (mech)
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hydrochloric acid converts Hg to digestive enzyme act upon the blood and change the color
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First thing to do if a person has a rectal bleed
**TEST |
IV ACCESS!! CENTRAL LINE
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Orhtostatic Hypertension (BP falls >10mm Hg) is usually indicative of bloodloss more than _____
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1000mL
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A patient has hematemesis that looks like "coffee grounds". What does this suggest?
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**Upper GI Bleed**
Blood has been altered by gastric acid |
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____ acts as an irritant to the GI tract
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Blood
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When you are evaluating a GI bleed, what should you do IMMEDIATELY?
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Nasogastric Aspiration and Lavage
Then, do an Endoscopy! |
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brown stool streaked with blood indicates:
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source in recto-sigmoidal or anal area
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a large volume of bright red blood indicates:
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colonic source
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maroon stools indicate:
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right colon lesion
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In persons older than 65, what is the source of most BIG colonic bleeds?
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1. Diverticulosis (most common)
2. Angiodysplasia (veins) |
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Are diverticular bleeds normally small or large?
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LARGE
(Remember, bleed is a problem of diverticulosis NOT diverticulitis) |
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When localizing a diverticular bleed, Technetium 99 Red Blood Cell Tagged (ITRBC) will show bleeding at a rate of ______
Arteriography will show bleeding at a rate of _______ |
ITRBC = 0.1 ml/min
Arteriography = 1.5 ml/min |
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Lower GI Bleeds in Elderly:
90% stop bleeding within ________ |
24-48hrs
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Meckel's Diverticulum:
____ is most common in adults ____ is most common in kids |
Adults: obstruction
Kids: bleeding (painless) **When inflamed, may present as appendicitis** |
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Interpret the possible returns from a nasogastric tube:
-Coffee Grounds -Red blood/clots -Bile Stained -Clear |
Coffee Grounds: slow bleeding/oozing
Red Blood/clots: active bleed Bile Stained: no active bleed above ligament of Treitz, bleed is proximal to 3rd duodenal segment Clear: GI bleeds are often intermittent and stop spontaneously. Clear return suggests pyloric closure but bleeding could be happening in duodenal bulb |
