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24 Cards in this Set
- Front
- Back
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What is the overall mortality of GI bleeding?
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10%
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What anatomic landmark divides GI bleeding into upper and lower GI bleed?
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- Ligament of Trietz (4th duodenal segment)
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List etologies of UGI/LGI bleeding in adults in decreasing frequency. Box 23-1.
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List etiologies of UGI and LGI bleeding in pediatrics. Box 23-2.
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What is the most common cause of massive LGI bleeding in children < 2 years old?
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- Meckle’s diverticulum
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What must be considered in patients with aortic grafts and rectal bleeding?
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aortoenteric fistula
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List causes of false positive hemoccult testing.
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- Ingestion of red fruit or red meat
- Methyline blue - Chlorophyll - Iodide - Cupuric acid - Bromide |
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List causes of false negative hemoccult testing.
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- Magnesium containing antacids
- Ascorbic acid-vit c |
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What else can cause black stool?
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Bismuth (pepto-bismol)
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In what % of patients with UGI bleeding will endoscopy identify a bleeding source?
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- 78-95%
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In what % of patients with active ongoing lower GI bleeding with angiography identify the site of bleeding?
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- 40-60%
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What is the indication for PPIs?
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- Documented high risk peptic ulcer disease at endoscopy (Reduced rebleeding and surgery)
- ?Undifferentiated UGI bleeding prior to endoscopy (Reduced stigmata of recent bleeding) |
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Evidence PPI and bleeding and peptic ulcer after endoscopy
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- Omeprazole infusion started after endoscopic therapy for high risk ulcers reduces the risk of 30 day rebleeding vs. placebo, with most of the benefit seen in the first 3 – 5 days (HR 2.9)
LAU NEJM 2000 - omeprazole (80mg bolus, 8mg/hr infusion for 72h) NNT 6 |
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PPIs FOR PEPTOIC ULCER DISEASE BLEEDING COCHRANE 2006?
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Plain Language Summary: In people with a bleeding ulcer in the stomach or duodenum there is no evidence of a difference in the risk of death if they are treated with a proton pump inhibitor, or and H2-receptor antagonist, or if they are given no specific drug treatments. However, proton pump inhibitors do reduce the risk of bleeding and the need for surgery
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PPI before endoscopy?
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Lau 2007 NEJM - b4 endoscopy
o Infusion of high dose omeprazole before endoscopy accelerated the resolution of signs of bleeding ulcers and reduced the need for endoscopic therapy - No Significant difference in need for blood transfusions, rebleeding, need for surgery or death |
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What is the indication for octreotide?
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documented esophageal varices
cochrane 2005 Plain Language Summary: Treating bleeding in the esophagus with somatoststin analogues does not appear to reduce deaths, but may lessen the need for blood transfusions 50 mcg bolus f/b 25 to 50 mcg/hr |
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What are additional therapies for bleeding varicies?
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- Vasopressin and nitroglycerin
- Sengstaken-Blakemore Tube - Endoscopy o Banding o Ligation o Sclerotherapy - Surgery |
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What are very low risk criteria for patients complaining of GI bleeding who can be discharged home? Box 23-3
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How are patients initial risk stratification in the ED in low, moderate, or high risk categoiries. Table 23-1
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age,BP,abnormal vitals, transfusion,comorbid,liver,high risk features
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Provide a table outlining disposition of GI bleed patients by their clinical and endoscoping risk stratification. Table 23-2
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What are general rules of thumb for indications for surgery for GI bleeding?
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- Hemodynamically unstable and unresponsive to resuscitation
- >5U PRBCs in 4-6hours - >2U PRBCs/4hours |
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What are the treatments for UGIB
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indications for blood transfusion?
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1. Continued active bleeding
2. Failure to improve perfusion and vital signs after infusion of 2L NS |
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Who should receive antibiotics?
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1. Antibiotics
1. Indicated for pts w/ cirrhosis or history of ETOH abuse (regardless of whether bleeding is variceal or not) 2. Ceftriaxone 1gm daily x 7 days 2. Erythromycin 1. Achieves endoscopy conditions equal to lavage 2. 3mg/kg IV over 20-30min, 30-90min prior to endoscopy |
