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21 Cards in this Set
- Front
- Back
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Overt Bleeding
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Visible Bleeding
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Occult Bleeding
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No obvious blood in feces
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Obscure Bleeding
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No Obvious source of bleeding found on endoscopy
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Tilt Test (Orthostatics
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Take BP/ pulse: laying, sitting, standing
*In elderly, if known to be orthostatic, dont make them stand |
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What is a positive tilt test?
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↓ systolic BP by 20mmHg+
OR ↓ diastolic BP by 10mmHg+ AND ↑ HR by 20bpm+ |
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Hypovolemic Shock
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Insuffieicent blood vol where normal blood vol cannot maintain tissue perfusion
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What are causes of Hypovolemic Shock?
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Hemorrhage or other fluid loss
Widespread VD of blood vessels |
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Common Symptoms of Hypovolemic Shock
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Low BP
Thready pulse Clammy skin Tachycardia and Tachypnea Reduced urinary output |
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Hematemesis
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Vomiting blood (bright red or coffee grounds)
associated with upper GI bleed A sever bleed of nose/nasopharynx may mimic |
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Melena
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Black, tarry, foul smelling stool
Upper GI bleed rarely with a slow lower GI bleed |
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Hematochezia
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Passage of bright red or maroon colored blood per rectum
Lower GI bleed Rarely a brisk upper GI bleed |
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Work up of Upper GI bleed
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Orthostatic BP
Labs IV Fluids Type and Cross ECG Radiologic Studies Endoscopy ...AKA do everything |
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Key aspects in the Medical Hx
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Prior Hx of GI bleed
GI symptoms Character of GI bleeding GI meds Gastrotoxic medications Anticoagulants Social Habits Medical Comorbidities |
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Hx: Vomiting retching
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Mallory-Weiss tear
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Hx: NSAID or ASA use or smoking
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Peptic ulcer disease
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Hx: Pt in the ICU
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Stress ulcer
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Hx: Alcoholism, cirrhosis of the liver
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Esophageal or gastric varices
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Hx: Weight loss, early satiety, smoking, alcohol
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Malignancy
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What to look for with the Physical Exam
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Hemodynamic stable
Signs of Shock Abdominal Exam Signs of Chronic Liver disease or portal hypertension rectal exam |
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How do you treat an upper GI bleed?
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Meds
Endoscopy Arteriography with embolization surgery patient education |
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What meds would be used?
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H2 Blocker
Proton Pump Inhibitors (PPI) Sucralfate Antibiotics |
