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57 Cards in this Set
- Front
- Back
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the most common cause of upper GI bleeds, accounting for approximately 50% of the cases
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Bleeding peptic ulcers (either duodenal or gastric
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the most common cause of upper GI bleeds, accounting for approximately 50% of the cases
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Bleeding peptic ulcers (either duodenal or gastric
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the most common cause of upper GI bleeds, accounting for approximately 50% of the cases
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Bleeding peptic ulcers (either duodenal or gastric
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Patients with duodenal ulcers often complain of
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sharp, burning, or gnawing epigastric pain that occurs hours after eating and wakes the patient from sleep. Pain is often relieved by food.
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Patients with duodenal ulcers often complain of
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sharp, burning, or gnawing epigastric pain that occurs hours after eating and wakes the patient from sleep. Pain is often relieved by food.
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Patients with duodenal ulcers often complain of
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sharp, burning, or gnawing epigastric pain that occurs hours after eating and wakes the patient from sleep. Pain is often relieved by food.
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Dieulafoy's lesion occurs when
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an aberrant submucosal arteriole bleeds upon erosion of the overlying mucosa. Dieulafoy's lesions are found throughout the GI tract but most commonly in the proximal stomach. Patients present classically with recurrent, painless, and massive hematemesis. A history of alcohol abuse or NSAID use is usually absent. Examination findings include signs of hemodynamic instability from the massive bleeding but are otherwise nonspecific.
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Dieulafoy's lesion occurs when
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an aberrant submucosal arteriole bleeds upon erosion of the overlying mucosa. Dieulafoy's lesions are found throughout the GI tract but most commonly in the proximal stomach. Patients present classically with recurrent, painless, and massive hematemesis. A history of alcohol abuse or NSAID use is usually absent. Examination findings include signs of hemodynamic instability from the massive bleeding but are otherwise nonspecific.
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Dieulafoy's lesion occurs when
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an aberrant submucosal arteriole bleeds upon erosion of the overlying mucosa. Dieulafoy's lesions are found throughout the GI tract but most commonly in the proximal stomach. Patients present classically with recurrent, painless, and massive hematemesis. A history of alcohol abuse or NSAID use is usually absent. Examination findings include signs of hemodynamic instability from the massive bleeding but are otherwise nonspecific.
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when an aberrant submucosal arteriole bleeds upon erosion of the overlying mucosa.
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Dieulafoy's lesion
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when an aberrant submucosal arteriole bleeds upon erosion of the overlying mucosa.
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Dieulafoy's lesion
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when an aberrant submucosal arteriole bleeds upon erosion of the overlying mucosa.
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Dieulafoy's lesion
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accounts for nearly 50% of the causes of lower GI bleeds
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Diverticulosis
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accounts for nearly 50% of the causes of lower GI bleeds
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Diverticulosis
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accounts for nearly 50% of the causes of lower GI bleeds
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Diverticulosis
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Diverticulosis accounts for nearly 50% of the causes of lower GI bleeds. A diverticulum is a sac-like protrusion from the colonic wall. Over time, the diverticulum continues to herniate and eventually the surrounding
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the surrounding vasa recta (at the neck or dome) become susceptible to rupture. Diverticula are most commonly found in the left colon. Patients typically present with large-volume, painless hematochezia. Some patients may also complain of bloating and cramping. Diverticular bleeding typically occurs in the absence of diverticulitis
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Diverticulosis accounts for nearly 50% of the causes of lower GI bleeds. A diverticulum is a sac-like protrusion from the colonic wall. Over time, the diverticulum continues to herniate and eventually the surrounding
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the surrounding vasa recta (at the neck or dome) become susceptible to rupture. Diverticula are most commonly found in the left colon. Patients typically present with large-volume, painless hematochezia. Some patients may also complain of bloating and cramping. Diverticular bleeding typically occurs in the absence of diverticulitis
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Angiodysplasia
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acquired vascular anomaly characterized by dilated, tortuous submucosal blood vessels lined by endothelial cells, but no smooth muscle cells.
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Angiodysplasia
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acquired vascular anomaly characterized by dilated, tortuous submucosal blood vessels lined by endothelial cells, but no smooth muscle cells.
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Angiodysplasia
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acquired vascular anomaly characterized by dilated, tortuous submucosal blood vessels lined by endothelial cells, but no smooth muscle cells.
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Angiodysplasia presents as painless hematochezia or melena and most often originates from the
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ascending colon or the cecum
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Angiodysplasia presents as painless hematochezia or melena and most often originates from the
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ascending colon or the cecum
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Colitis is simply a colonic mucosal inflammation in response to acute injury. Colitis can be infectious, ischemic, or inflammatory in origin. The clinical presentation is similar in all types of colitis.
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Patients classically present with hematochezia (with or without diarrhea), abdominal pain, and fever.
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Colitis is simply a colonic mucosal inflammation in response to acute injury. Colitis can be infectious, ischemic, or inflammatory in origin. The clinical presentation is similar in all types of colitis.
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Patients classically present with hematochezia (with or without diarrhea), abdominal pain, and fever.
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Colitis is simply a colonic mucosal inflammation in response to acute injury. Colitis can be infectious, ischemic, or inflammatory in origin. The clinical presentation is similar in all types of colitis.
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Patients classically present with hematochezia (with or without diarrhea), abdominal pain, and fever.
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The most common organisms associated with food poisoning include invasive bacteria such as
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Campylobacter, Salmonella, and Shigella and bacteria that produce cytotoxins such as Escherichia coli (serotype O157:H7). Clostridium difficile is associated with previous antibiotic use and also produces a cytotoxin. On examination, patients with infectious colitis can have severe abdominal pain with peritoneal signs suggesting a surgical abdomen. Routine stool cultures and toxin assays will identify the most common causes of infectious colitis.
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The most common organisms associated with food poisoning include invasive bacteria such as
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Campylobacter, Salmonella, and Shigella and bacteria that produce cytotoxins such as Escherichia coli (serotype O157:H7). Clostridium difficile is associated with previous antibiotic use and also produces a cytotoxin. On examination, patients with infectious colitis can have severe abdominal pain with peritoneal signs suggesting a surgical abdomen. Routine stool cultures and toxin assays will identify the most common causes of infectious colitis.
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The most common organisms associated with food poisoning include invasive bacteria such as
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Campylobacter, Salmonella, and Shigella and bacteria that produce cytotoxins such as Escherichia coli (serotype O157:H7). Clostridium difficile is associated with previous antibiotic use and also produces a cytotoxin. On examination, patients with infectious colitis can have severe abdominal pain with peritoneal signs suggesting a surgical abdomen. Routine stool cultures and toxin assays will identify the most common causes of infectious colitis.
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The most common organisms associated with food poisoning include invasive bacteria such as
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Campylobacter, Salmonella, and Shigella and bacteria that produce cytotoxins such as Escherichia coli (serotype O157:H7). Clostridium difficile is associated with previous antibiotic use and also produces a cytotoxin. On examination, patients with infectious colitis can have severe abdominal pain with peritoneal signs suggesting a surgical abdomen. Routine stool cultures and toxin assays will identify the most common causes of infectious colitis.
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The most common organisms associated with food poisoning include invasive bacteria such as
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Campylobacter, Salmonella, and Shigella and bacteria that produce cytotoxins such as Escherichia coli (serotype O157:H7). Clostridium difficile is associated with previous antibiotic use and also produces a cytotoxin. On examination, patients with infectious colitis can have severe abdominal pain with peritoneal signs suggesting a surgical abdomen. Routine stool cultures and toxin assays will identify the most common causes of infectious colitis.
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schemic colitis usually occurs in elderly patients with associated
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hypotension, heart failure, or arrhythmia. On examination, patients may be hypotensive and will have severe lower abdominal tenderness. Often, physical signs of peritonitis are seen.
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schemic colitis usually occurs in elderly patients with associated
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hypotension, heart failure, or arrhythmia. On examination, patients may be hypotensive and will have severe lower abdominal tenderness. Often, physical signs of peritonitis are seen.
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schemic colitis usually occurs in elderly patients with associated
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hypotension, heart failure, or arrhythmia. On examination, patients may be hypotensive and will have severe lower abdominal tenderness. Often, physical signs of peritonitis are seen.
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The initial evaluation of an acute GI bleed requires
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assessment of hemodynamic stability and an identification of risk factors for mortality from an acute GI bleed (Table 3.3). Blood loss of less than 500 mL rarely causes systemic signs but greater volumes result in symptomatic orthostatic hypotension.
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The initial evaluation of an acute GI bleed requires
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assessment of hemodynamic stability and an identification of risk factors for mortality from an acute GI bleed (Table 3.3). Blood loss of less than 500 mL rarely causes systemic signs but greater volumes result in symptomatic orthostatic hypotension.
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The initial evaluation of an acute GI bleed requires
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assessment of hemodynamic stability and an identification of risk factors for mortality from an acute GI bleed (Table 3.3). Blood loss of less than 500 mL rarely causes systemic signs but greater volumes result in symptomatic orthostatic hypotension.
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All patients with GI bleeding should immediately receive
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two large-bore (18 gauge) catheters or a central venous line for intravenous access. Patients should be stabilized with fluid replacement or blood transfusions. Coagulopathy or
P.17 electrolyte disturbances should be corrected. Patients with overt major bleeding should have intensive care monitoring. Once a patient is stabilized, further diagnostic evaluation can be done. |
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All patients with GI bleeding should immediately receive
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two large-bore (18 gauge) catheters or a central venous line for intravenous access. Patients should be stabilized with fluid replacement or blood transfusions. Coagulopathy or
P.17 electrolyte disturbances should be corrected. Patients with overt major bleeding should have intensive care monitoring. Once a patient is stabilized, further diagnostic evaluation can be done. |
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All patients with GI bleeding should immediately receive
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two large-bore (18 gauge) catheters or a central venous line for intravenous access. Patients should be stabilized with fluid replacement or blood transfusions. Coagulopathy or
P.17 electrolyte disturbances should be corrected. Patients with overt major bleeding should have intensive care monitoring. Once a patient is stabilized, further diagnostic evaluation can be done. |
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An important caveat in the setting of an acute, rapid GI bleed is that the initial hemoglobin may not accurately reflect the magnitude of blood loss as it takes approximately
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8 hours for equilibration with extravascular fluid. Other essential laboratory tests include a basic chemistry for electrolytes, blood urea nitrogen (BUN), and creatinine. An increased BUN/creatinine ratio greater than 25:1 suggests an upper GI source. The BUN increases due to breakdown of blood products to urea by intestinal bacteria and when there is a concomitant reduction in the glomerular filtration rate.
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An important caveat in the setting of an acute, rapid GI bleed is that the initial hemoglobin may not accurately reflect the magnitude of blood loss as it takes approximately
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8 hours for equilibration with extravascular fluid. Other essential laboratory tests include a basic chemistry for electrolytes, blood urea nitrogen (BUN), and creatinine. An increased BUN/creatinine ratio greater than 25:1 suggests an upper GI source. The BUN increases due to breakdown of blood products to urea by intestinal bacteria and when there is a concomitant reduction in the glomerular filtration rate.
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An important caveat in the setting of an acute, rapid GI bleed is that the initial hemoglobin may not accurately reflect the magnitude of blood loss as it takes approximately
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8 hours for equilibration with extravascular fluid. Other essential laboratory tests include a basic chemistry for electrolytes, blood urea nitrogen (BUN), and creatinine. An increased BUN/creatinine ratio greater than 25:1 suggests an upper GI source. The BUN increases due to breakdown of blood products to urea by intestinal bacteria and when there is a concomitant reduction in the glomerular filtration rate.
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If the EGD is negative and the patient presents with hematochezia, then
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If a patient remains hemodynamically unstable, then endoscopy must be done urgently and EGD is the first choice regardless of whether a patient presents with hematemesis, melena, or hematochezia. If the EGD is negative and the patient presents with hematochezia, then colonoscopy is indicated. If the colonoscopy is negative, then enteroscopy can be performed to look at the upper portions of the small intestine (proximal jejunum). If the EGD is
P.18 negative and the patient presents with hematemesis, then enteroscopy can be performed. If enteroscopy is negative, then angiography or surgery is needed to localize the bleeding source. |
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If the EGD is negative and the patient presents with hematochezia, then
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If a patient remains hemodynamically unstable, then endoscopy must be done urgently and EGD is the first choice regardless of whether a patient presents with hematemesis, melena, or hematochezia. If the EGD is negative and the patient presents with hematochezia, then colonoscopy is indicated. If the colonoscopy is negative, then enteroscopy can be performed to look at the upper portions of the small intestine (proximal jejunum). If the EGD is
P.18 negative and the patient presents with hematemesis, then enteroscopy can be performed. If enteroscopy is negative, then angiography or surgery is needed to localize the bleeding source. |
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If the EGD is negative and the patient presents with hematochezia, then
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If a patient remains hemodynamically unstable, then endoscopy must be done urgently and EGD is the first choice regardless of whether a patient presents with hematemesis, melena, or hematochezia. If the EGD is negative and the patient presents with hematochezia, then colonoscopy is indicated. If the colonoscopy is negative, then enteroscopy can be performed to look at the upper portions of the small intestine (proximal jejunum). If the EGD is
P.18 negative and the patient presents with hematemesis, then enteroscopy can be performed. If enteroscopy is negative, then angiography or surgery is needed to localize the bleeding source. |
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If a patient remains hemodynamically unstable, then endoscopy must be done urgently and EGD is the first choice regardless of whether a patient presents with hematemesis, melena, or hematochezia. If the EGD is negative and the patient presents with hematochezia, then colonoscopy is indicated. If the colonoscopy is negative, then enteroscopy can be performed to look at the upper portions of the small intestine (proximal jejunum). If the EGD is
P.18 negative and the patient presents with hematemesis, then enteroscopy can be performed. If enteroscopy is negative, then angiography or surgery is needed to localize the bleeding source. |
If a patient remains hemodynamically unstable, then endoscopy must be done urgently and EGD is the first choice regardless of whether a patient presents with hematemesis, melena, or hematochezia. If the EGD is negative and the patient presents with hematochezia, then colonoscopy is indicated. If the colonoscopy is negative, then enteroscopy can be performed to look at the upper portions of the small intestine (proximal jejunum). If the EGD is
P.18 negative and the patient presents with hematemesis, then enteroscopy can be performed. If enteroscopy is negative, then angiography or surgery is needed to localize the bleeding source. |
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If a patient remains hemodynamically unstable, then endoscopy must be done urgently and EGD is the first choice regardless of whether a patient presents with hematemesis, melena, or hematochezia. If the EGD is negative and the patient presents with hematochezia, then colonoscopy is indicated. If the colonoscopy is negative, then enteroscopy can be performed to look at the upper portions of the small intestine (proximal jejunum). If the EGD is
P.18 negative and the patient presents with hematemesis, then enteroscopy can be performed. If enteroscopy is negative, then angiography or surgery is needed to localize the bleeding source. |
If a patient remains hemodynamically unstable, then endoscopy must be done urgently and EGD is the first choice regardless of whether a patient presents with hematemesis, melena, or hematochezia. If the EGD is negative and the patient presents with hematochezia, then colonoscopy is indicated. If the colonoscopy is negative, then enteroscopy can be performed to look at the upper portions of the small intestine (proximal jejunum). If the EGD is
P.18 negative and the patient presents with hematemesis, then enteroscopy can be performed. If enteroscopy is negative, then angiography or surgery is needed to localize the bleeding source. |
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If the EGD is negative and the patient presents with hematochezia, then
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If a patient remains hemodynamically unstable, then endoscopy must be done urgently and EGD is the first choice regardless of whether a patient presents with hematemesis, melena, or hematochezia. If the EGD is negative and the patient presents with hematochezia, then colonoscopy is indicated. If the colonoscopy is negative, then enteroscopy can be performed to look at the upper portions of the small intestine (proximal jejunum). If the EGD is
P.18 negative and the patient presents with hematemesis, then enteroscopy can be performed. If enteroscopy is negative, then angiography or surgery is needed to localize the bleeding source. |
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If the EGD is negative and the patient presents with hematochezia, then
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If a patient remains hemodynamically unstable, then endoscopy must be done urgently and EGD is the first choice regardless of whether a patient presents with hematemesis, melena, or hematochezia. If the EGD is negative and the patient presents with hematochezia, then colonoscopy is indicated. If the colonoscopy is negative, then enteroscopy can be performed to look at the upper portions of the small intestine (proximal jejunum). If the EGD is
P.18 negative and the patient presents with hematemesis, then enteroscopy can be performed. If enteroscopy is negative, then angiography or surgery is needed to localize the bleeding source. |
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If the EGD is negative and the patient presents with hematochezia, then
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If a patient remains hemodynamically unstable, then endoscopy must be done urgently and EGD is the first choice regardless of whether a patient presents with hematemesis, melena, or hematochezia. If the EGD is negative and the patient presents with hematochezia, then colonoscopy is indicated. If the colonoscopy is negative, then enteroscopy can be performed to look at the upper portions of the small intestine (proximal jejunum). If the EGD is
P.18 negative and the patient presents with hematemesis, then enteroscopy can be performed. If enteroscopy is negative, then angiography or surgery is needed to localize the bleeding source. |
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If a patient remains hemodynamically unstable, then endoscopy must be done urgently and EGD is the first choice regardless of whether a patient presents with hematemesis, melena, or hematochezia. If the EGD is negative and the patient presents with hematochezia, then colonoscopy is indicated. If the colonoscopy is negative, then enteroscopy can be performed to look at the upper portions of the small intestine (proximal jejunum). If the EGD is
P.18 negative and the patient presents with hematemesis, then enteroscopy can be performed. If enteroscopy is negative, then angiography or surgery is needed to localize the bleeding source. |
If a patient remains hemodynamically unstable, then endoscopy must be done urgently and EGD is the first choice regardless of whether a patient presents with hematemesis, melena, or hematochezia. If the EGD is negative and the patient presents with hematochezia, then colonoscopy is indicated. If the colonoscopy is negative, then enteroscopy can be performed to look at the upper portions of the small intestine (proximal jejunum). If the EGD is
P.18 negative and the patient presents with hematemesis, then enteroscopy can be performed. If enteroscopy is negative, then angiography or surgery is needed to localize the bleeding source. |
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If a patient remains hemodynamically unstable, then endoscopy must be done urgently and EGD is the first choice regardless of whether a patient presents with hematemesis, melena, or hematochezia. If the EGD is negative and the patient presents with hematochezia, then colonoscopy is indicated. If the colonoscopy is negative, then enteroscopy can be performed to look at the upper portions of the small intestine (proximal jejunum). If the EGD is
P.18 negative and the patient presents with hematemesis, then enteroscopy can be performed. If enteroscopy is negative, then angiography or surgery is needed to localize the bleeding source. |
If a patient remains hemodynamically unstable, then endoscopy must be done urgently and EGD is the first choice regardless of whether a patient presents with hematemesis, melena, or hematochezia. If the EGD is negative and the patient presents with hematochezia, then colonoscopy is indicated. If the colonoscopy is negative, then enteroscopy can be performed to look at the upper portions of the small intestine (proximal jejunum). If the EGD is
P.18 negative and the patient presents with hematemesis, then enteroscopy can be performed. If enteroscopy is negative, then angiography or surgery is needed to localize the bleeding source. |
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GI bleeding eval flow chart
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there
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Angiography requires active blood loss of approximately what to be visualized
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1.0 to 1.5 mL/minute for a bleeding site to be visualized, whereas a tagged red blood scan requires bleeding rates as low as 0.1 to 0.5 mL/min. GI studies with barium are contraindicated in patients with acute upper or lower GI bleeds because they will interfere with endoscopy, angiography, or surgery, if required
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Angiography requires active blood loss of approximately what to be visualized
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1.0 to 1.5 mL/minute for a bleeding site to be visualized, whereas a tagged red blood scan requires bleeding rates as low as 0.1 to 0.5 mL/min. GI studies with barium are contraindicated in patients with acute upper or lower GI bleeds because they will interfere with endoscopy, angiography, or surgery, if required
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Angiography requires active blood loss of approximately what to be visualized
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1.0 to 1.5 mL/minute for a bleeding site to be visualized, whereas a tagged red blood scan requires bleeding rates as low as 0.1 to 0.5 mL/min. GI studies with barium are contraindicated in patients with acute upper or lower GI bleeds because they will interfere with endoscopy, angiography, or surgery, if required
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Angiography requires active blood loss of approximately what to be visualized
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1.0 to 1.5 mL/minute for a bleeding site to be visualized, whereas a tagged red blood scan requires bleeding rates as low as 0.1 to 0.5 mL/min. GI studies with barium are contraindicated in patients with acute upper or lower GI bleeds because they will interfere with endoscopy, angiography, or surgery, if required
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