2.2 Cs Exam 2: Gi Bleeding

Front 1

what is the definition of acute GI bleeding?

Back 1

overt bleeding: visible blood.
or
Occult bleeding: invisible

Front 2

what are the 3 types of overt bleeding associated w/ the GI? describe each one.

Back 2

melena- black colored, foul smelling. tar consistency stool
hematemesis- vomiting blood (bright blood vs coffee ground emesis)
hematochezia- bright red or maroon stool (BRISK upper vs lower GI source)

Front 3

how do you define Upper GI bleeding?

Back 3

blood loss w/n the intraluminal GI tract btwn esophagus & ligament of treitz.

Front 4

how do you approach a pt w/ an UGI bleed?

Back 4

1) prompt stabilization/ resuscitation (make sure they are stable)
2) assessment of onset/ severity
3) DDX
4) prep for emergent endoscopy
5) control active bleeding
6) minimize tx complications
7) tx rebleeding episodes.

Front 5

what is the time frame for an emergent endoscopy?

Back 5

12-24 hrs

Front 6

when do you need to protect the airway of a person w/ an UGI bleed?

Back 6

when the pt is actively vomiting blood in order to prevent the blood from going into their lungs.

Front 7

what size IV to use to get fluids back into a person who has an upper GI bleed?

Back 7

2 large caliber peripheral IVs: 18 gauge or larger.

Front 8

what BUN:Cr ration is suggestive of an upper GI bleed?

Back 8

30:1

Front 9

what associated sxs would you see in pts with these varying amounts of blood loss?
1) 500ml
2) 1000ml
3) 2000ml

Back 9

1) minimal to no sxs
2) postural changes in BP & pulse- orthostasis (drop in SBP at least 10-20 mmHg & rise in pulse rate of 20 BPM)
3) often w/ clinical shock.

Front 10

what are the signs & sxs associated w/ acute GI bleed?

Back 10

hematemesis, coffee ground emesis, melena, hematochezia, tachycardia, orthostasis, syncope, hypotensive shock, MI, cardiopulmonary arrest.

Front 11

what signs & sxs are associated w/ chronic GI bleed?

Back 11

weakness, lethargy, heme + stool and dec iron.

Front 12

if the hemoccult comes back positive, is that considered emergent or non emergent?

Back 12

non-emergent

Front 13

what is on the DDX of UGIB in the esophagus?

Back 13

varices, esophagitis, mallory-weiss tear (& assoc boerhaave syndrome)

Front 14

what is on the DDX of UGIB in the stomach?

Back 14

varices, ulcer dz, gastropathy/ gastritis/ AVM, Cameron' lesion (hiatal hernia going in & out of diaphragm --> transient periods of loss of blood flow--. areas of ischemia) and dieulafoy's lesion

Front 15

what is on the DDX of UGIB in the duodenal?

Back 15

ulcers, varices, AVM's

Front 16

what is on the DDX of UGIB besides esophagus, gastric & duodenal issues?

Back 16

neoplasia &nasal/ pharyngeal trauma

Front 17

what is the standard of care for pt w/ GI bleed? (as far as diagnostics)

Back 17

1st endoscopy
2nd IV radiology
last- surgery

Front 18

what pts w/ an UGI bleed will be admitted to the ICU?

Back 18

hemodynamic instability, respiratory failure, active bleeding

Front 19

what is the tx for acute management of an UGI bleed?

Back 19

IV PPI + urgent endoscopy (12-24 hrs)

*can do clipping on endoscopy to stop bleed**

Front 20

What endoscopic findings indicate that recurrent bleeding is likely?

(clean based ulcer, red spot, & adherent clots are NOT likley!--> can send these pts home)

Back 20

Visible vessel or active bleed--> recurrent bleeding likely

Front 21

what is the ideal pH for hemostasis (bleeding to stop)?

what helps to achieve this?

Back 21

7.4

protonix drip

(ulcer healing best > 4, coagulation > 5.9)

Front 22

what is a mallory-weiss tear? how do you tx it?

Back 22

often present w/ prolonged wretching --> esophageal tear d/t wretching.
tx: conservative if pt is hemodynamically stable. Majority stop bleeding spontaneously. Endoscopic thx for persistent bleeding

Front 23

what is the therapy for variceal bleeding?

Back 23

-Fluoroquinolones antibiotics reduce short term mortality, *always give if pt has liver dz**

-octreotide (dec splanchnic pressure/ dec portal pressure),

-endoscopy,

-transjugular intrahepatic portosystemic shunt (TIPS) or shunt surgery

Front 24

what is the #1 cause of variceal bleeding?

Back 24

cirrhosis... is so add antibiotics to the regimen.

Front 25

what is usually MC organ that causes LGI bleed?

what is the MCC of lower GI bleed?

2nd MCC?

*usually presents as hematochezia (stool w/ blood)

Back 25

organ: colon
MCC: diverticulum--> MC in Left colon* but MC bleeding from Right colon*
2nd MCC; angiodysplasia (AVM) = dilated submucosal vessels--> MC bleed in ascending colon or cecum

Front 26

what findings are indicative for angiographic embolization?

Back 26

rebleeding & severe bleeding

Front 27

when is surgery done on a pt w/ a LGI bleed?

Back 27

after gastroenterologist & interventional radiology.

must have: torrential bleeding, refractory rebleeding, rebleeding w/ shock, transfusion > 4-6 units/ resuscitative event

*last resort always*

Front 28

which bleed is closely associated with age upper or lower?

Back 28

lower. average age 65-- either diverticulosis or AVM, if pain think ischemic colitis

Front 29

which bleed is closely associated with a high mortality rate?

Back 29

lower. recurrent or persistent bleeding KILLS.

Front 30

what percentage of lower GI bleeds stop spontaneously?

Back 30

80%

Front 31

which bleed is more serious, lower or upper?

Back 31

UGI bleed

*EMERGENCY!!

Front 32

what is step 1 in the care of an UGI bleed? step 2?

Back 32

determine stability then admit to ICU (if necessary) & monitor flow vitals.