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32 Cards in this Set

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  • Back

what is the definition of acute GI bleeding?

overt bleeding: visible blood.
Occult bleeding: invisible

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

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)

how do you define Upper GI bleeding?

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

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

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.

what is the time frame for an emergent endoscopy?

12-24 hrs

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

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

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

2 large caliber peripheral IVs: 18 gauge or larger.

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


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

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.

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

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

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

weakness, lethargy, heme + stool and dec iron.

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

what is on the DDX of UGIB in the esophagus?

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

what is on the DDX of UGIB in the stomach?

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

what is on the DDX of UGIB in the duodenal?

ulcers, varices, AVM's

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

neoplasia &nasal/ pharyngeal trauma

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

1st endoscopy
2nd IV radiology
last- surgery

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

hemodynamic instability, respiratory failure, active bleeding

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

IV PPI + urgent endoscopy (12-24 hrs)

*can do clipping on endoscopy to stop bleed**

What endoscopic findings indicate that recurrent bleeding is likely?

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

Visible vessel or active bleed--> recurrent bleeding likely

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

what helps to achieve this?


protonix drip

(ulcer healing best > 4, coagulation > 5.9)

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

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

what is the therapy for variceal bleeding?

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

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


-transjugular intrahepatic portosystemic shunt (TIPS) or shunt surgery

what is the #1 cause of variceal bleeding?

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

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)

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

what findings are indicative for angiographic embolization?

rebleeding & severe bleeding

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

after gastroenterologist & interventional radiology.

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

*last resort always*

which bleed is closely associated with age upper or lower?

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

which bleed is closely associated with a high mortality rate?

lower. recurrent or persistent bleeding KILLS.

what percentage of lower GI bleeds stop spontaneously?


which bleed is more serious, lower or upper?

UGI bleed


what is step 1 in the care of an UGI bleed? step 2?
determine stability then admit to ICU (if necessary) & monitor flow vitals.