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23 Cards in this Set
- Front
- Back
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1. Next step in management of class I haemorrhagic shock from lower GI bleeding?
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a. Volume resuscitation with Isotonic crystalloid solution and close monitoring of his response to resuscitation.
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2. Definitive method to r/o duodenal source of bleeding?
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a. EGD
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3. What does the passage of maroon-coloured stool and blood clots generally indicate?
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a. Lower GI bleed (distal to ligament of Treitz).
b. Maroon-coloured stools represent a mixture of fecal material and blood, indicating that the bleeding source is located proximal to the lower rectal segment and anus. c. Passage of blood-clots can also occur w/brisk bleeding from an Upper tract GI source. |
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4. Easiest way to r/o upper GI bleed?
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a. Placement of an NG tube during initial eval. Although up to 16% of pts may have non-bloody NG aspirate w/upper GI tract bleed originating from the duodenum.
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5. 3 most common causes of lower GI tract bleeding in pts older than 40?
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1. Diverticulosis
2. Angiodysplasia 3. Neoplasm b. These lesions are generally painless. |
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6. 4 things to consider when lower GI bleeding occurs in the presence of abdominal pain?
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a. Ischaemic bowel
b. IBD c. Intussusception d. Ruptured Abdominal Aneurysm. |
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7. Primary goal in tx of a pt w/acute and continued lower GI bleeding?
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a. Localization of the bleeding site via:
1. Colonoscopy 2. Mesenteric angiography 3. and/or isotope-labelled RBC scan. |
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8. 3 most common causes of Overt lower GI tract bleeding in children?
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1. Meckel diverticulum
2. IBD 3. Polyps |
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9. Most common causes of over GI bleeding in adults 20-60?
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a. Diverticulosis
b. Neoplasm c. Inflammatory bowel disease |
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10. Tagged RBC scan?
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a. Nuclear medicine imaging using RBCs labelled with technetium 99m.
b. This is highly sensitive in identifying active bleeding at a rate of 0.1 mL/min or greater. c. However, the images obtained may not localize the GI tract bleeding site accurately. d. Some recommend this imaging modality as an initial screening study before performing mesenteric angiography. |
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11. Mesenteric Angiography?
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a. Selective angiography of the superior and inferior mesenteric arteries can localize bleeding from the midgut and hindgut.
b. This procedure has greater specificity for bleeding localization than a tagged-RBC scan. c. Selective injection of vasopressin or gel foam can be applied to during angiography to treat active bleeding in pts who are not suitable surgical candidates. d. The bleeding generally has to be 0.5-1.0 mL/min to be visualized during angiography. |
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12. Video capsule endoscopy?
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a. A small capsular video camera can be swallowed to provide visualization of the entire GI tract lumen.
b. This study is time-consuming and does not offer therapeutic options for pts w/acute bleeding. |
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13. Rigid proctosigmoidoscopy?
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a. A simple bedside procedure in which a nonflexible endoscopy is used to visualize the most distal 25-cm segment of the lower GI trat.
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14. What category of pts is colonoscopy reserved for?
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a. Hemodynamically stable pts.
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15. Advantages of colonoscopy?
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a. Can r/o the possibility of a colorectal bleeding source
b. Identified angiodysplasia can be treated with epinephrine injection or coagulation. |
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16. Angiodysplasia?
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a. A common acquired degenerative vascular condition producing small, dilated, thin-walled veins in the submucosa of the GI tract.
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17. Where does Angiodysplasia most commonly occur?
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a. In the cecum and ascending colon of people older than 50 yrs old.
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18. Common comorbidities w/angiodysplasia?
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a. ~50% of pts have associated cardiac disease.
b. Up to 25% have aortic stenosis c. Most pts w/angiodysplasia have chronic low-grade, self-limited bleeding, although ~15% present w/acute massive bleeding. |
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19. What must be strongly considered and ruled out with respect to GI bleeding in a pt who had a previous abdominal vascular reconstruction?!
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a. Aortoenteric fistula!
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20. Melena?
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a. Melena (tarry stool) indicates the degradation of haemoglobin by bacteria and forms after blood has remained in the GI tract for more than 14 hours.
b. Melena is usually associated w/upper GI tract or SI bleeds but can occur w/bleeding from the ascending colon. |
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21. Significance of maroon-coloured stools?
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a. Generally excludes a possible bleeding source in the rectum and anus.
b. Bleeding from the rectum is usually characterized by the passage of formed stools streaked w/blood or the passage of fresh blood at the end of a normal bowel movement. |
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22. With what sx is aortoenteric fistula following aortic reconstruction nearly always associated?
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a. Painless hematochezia.
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23. What test has the highest specificity in identifying the source of lower GI tract bleeding?
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a. Colonoscopy. (ie, the lowest false-positive rate for bleeding source identification.
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