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18 Cards in this Set
- Front
- Back
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where is the border between upper/lower GI bleeding?
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ligament of Treitz (duodenum)
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what test should you order first in a pt with hematemesis?
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upper GI endoscopy
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what test should you order first in a pt with hematochezia?
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r/o anorectal cause (hemorrhoids)
colonoscopy (colon CA main concern) |
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what test should you order first in a pt with melana?
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upper GI endoscopy (upper bleed mc > lower) colonoscopy if upper is nl
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what test should you order first in a pt with occult blood?
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colonoscopy (colon CA main concern)
upper endoscopy if nl |
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what is the mc cause of lower GI bleeding in a pt younger/older than 60?
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(<60) - diverticulosis
(>60) - angiodysplasia |
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what can cause dark stools?
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melana
bismuth iron spinach charcoal |
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how far down the GI tract is the furthest you can expect a bleed to cause melana?
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ascending colon
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what should you always ask pts who have GI bleeding?
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if they take NSAIDS/aspirin or anticoagulants
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what finding on CBC is suggestive of iron deficiency anemia?
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low mean corpuscular volume (MCV)
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what happens to the BUN-creatinine ratio in upper GI bleeding?
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it becomes elevated
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what is the most accurate diagnostic test in the evaluation of upper GI bleeding?
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upper GI endoscopy
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what is often the initial procedure for determining whether GI bleeding is from and upper vs lower GI source?
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nasogastric tube
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how does a bleeding (radionuclide) scan aid in the diagnosis of GI bleeding?
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identifies low rate continuous bleeding
(however, does not localize the lesion) |
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what study definitively locates the point of GI bleeding?
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arteriography:
- mainly for lower GI bleeding - perform during active bleeding - therapeutic with vasopressin infusion |
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what is the treatment of choice in an upper GI bleed?
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EGD w/ coagulation
(if bleeding continues, try again or surgical vessel ligation) |
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what are the (3) possible treatments in a lower GI bleed?
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colonoscopy
arteriographic vasoconstrictor infusion surgical resection |
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what are the indications for surgery for a GI bleed?
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unresponsive hemodynamic instability
severe initial/recurrent bleed >24hrs visible vessel continuous transfusion req (5U w/in 5hrs) |
