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MEDI Semester 2, Block 1 (GI Bleeding)
Terms in this set (54)
Hematochezia is bright red blood in the stool. It is more characteristic of upper/lower GI bleed.
Melena is dark, tarry stool. It is more characteristic of upper/lower GI bleed.
Hematemesis is bright red or coffee ground vomit. It is more characteristic of upper/lower GI bleed.
What are three signs of upper GI bleed?
Hyperactive bowel sounds
Hematochezia is more characteristic of lower GI bleed. The most common cause of lower GI bleed is:
Occult bleeding is defined by no obvious bleeding in the GI tract but a positive:
Fecal occult blood test or iron deficient anemia finding
An upper GI bleed is classified as such as the source of the bleed is:
Above the ligament of Treitz
The source of a lower GI bleed is below the:
Ligament of Treitz
The ligament of Treitz is also called the suspensory ligament of the duodenum. It serves as the landmark for classifying upper vs lower GI bleeds. What part of the duodenum does this ligament attach to?
The 4th part (ascending part)
Contrary to popular belief, complications from GI bleeds more often occur from ____________________ rather than blood loss.
Inadequate circulatory volume
In the management of an acute GI bleed, remember to S.E.T. This acronym stands for:
Stabilize the patient (vitals and place 2 large bore IVs)
Evaluate the patient
Treat the patient
In the management of acute GI bleed, it is important to obtain orthostatics. Positive orthostatics are defined as:
An increase of 10 bpm in heart rate upon sitting up from lying down
Mental status change
Positive orthostatics imply how much total blood loss?
15% loss of total blood
You have a patient who presents to your clinic with complaint of bloody stools. Their vitals are as follows: HR 100 bpm, BP 100/68, RR 16, Temp 99. First set of orthostatics: patient's BP drops slightly and HR increases to 112 bpm. You estimate the patient has lost about what percentage of total blood?
An increase in _____ bpm in heartrate implies positive orthostatics, implying a 15% blood loss.
If a hemoglobin level is 7 or lower, you should transfuse the patient. Give a scenario in which you would still transfuse the patient with a hemoglobin of 8.5.
As Hgb levels take about 48 hours to drop after an internal bleeding event, a Hgb level of 8.5 in combination with clinical findings (weakness, fatigue, hypotension, etc) would warrant transfusion as well
Hyperactive bowel sounds generally points to upper/lower GI bleed.
Upper GI bleed
An elevated BUN is indicative of an upper /lower GI bleed.
Upper GI bleed
You have a patient who presents to the ED with acute GI bleed. This patient is 60 years old with history of liver disease and kidney failure. You would admit this patient to:
You have a patient who is unstable with hematochezia. You should immediately:
You have a patient who is stable with complaint of intermittent bloody stool. For this patient, EGD/colonoscopy is more appropriate.
In the case of acute GI bleeds, you should never get what type of imaging study?
Barium imaging is never indicated in acute GI bleed
Up to 90% of acute GI bleeds resolve spontaneously. However, it is still important to find the source of the bleeding and address the cause. Acute GI bleeds are found proximal to:
The ligament of Treitz
In chronic GI bleeds, fecal occult tests will yield a _____ color.
Chronic GI bleeds are generally less urgent and can be managed on an _________________ basis.
Patients with chronic GI bleeds may present with reduced Hgb levels with no hemodynamics changes. In these types of patients, it is important to think about iron deficiency anemia and look for a low _____ finding.
Iron deficiency anemia supported by a low MVC finding is characteristic of acute/chronic GI bleed
In general, an EGD is more adept at finding a(n) ___________ GI bleed, while a colonoscopy is more adept at finding a(n) ___________ GI bleed.
You have a patient who presents to your clinic with complaint of bloody stools. Both EGD and colonoscopy are unremarkable. At this point, you are now thinking the source is:
The small intestine
You have a patient who presents to your clinic with complaint of bloody stools. Both EGD and colonoscopy are unremarkable. At this point, you are now thinking the source is the small bowel. To evaluate for a small bowel bleed, what type of imaging study is useful?
Barium imaging studies
What are two helpful clues of an upper GI bleed that are not diagnostic?
Hyperactive bowel sounds
Upper GI bleed source?
Proximal to the suspensory ligament of the duodenum (ligament of Treitz)
The most common cause of lower GI bleed is hemorrhoids. However, this is not the most clinically significant or concerning finding. The most common cause of SIGNIFICANT lower GI bleed in adults is:
50% of cases of upper GI bleeds are caused by:
Peptic ulcer disease
What are two precipitating factors of peptic ulcer disease?
H. Pylori infection
The risk of re-bleed from a peptic ulcer is high if:
Visible vessel is seen on endoscopy OR active bleeding is seen on endoscopy
The risk of re-bleed from a peptic ulcer is low if:
A clean-based ulcer is seen on EGD
Esophageal varices can cause upper GI bleeding. They are caused by:
Liver disease and poor blood flow to the liver
UGI bleed due to esophageal varices actually has poorer outcomes than UGI bleed due to peptic ulcer disease. Why?
Patients with esophageal varices are already affected by other disease states (liver cirrhosis or liver disease)
Linear lacerations in the distal esophagus and gastric side of the GE junction that are most commonly due to retching and vomiting are:
Gastritis is commonly caused by stress, alcohol use, NSAID use, and H. Pylori infection. It is usually not a major cause of UGI bleed. However, it is a good idea to treat critically ill patients with gastritis with:
A PPI or H2 receptor blocker to prevent bleeding due to gastritis
Mallory-Weiss tears most commonly result due to retching and vomiting. Which patient population is especially at risk of Mallory-Weiss tears?
Esophagitis can result due to a plethora of causes. It is primarily characterized by odynophagia. Odynophagia is:
Esophageal cancer is another potential cause of upper GI bleed. The risk factors for adenocarcinoma and carcinoma are what, respectively?
Esophageal adenocarcinoma: Barrett Esophagus, reflux
Esophageal carcinoma: smoking/drinking
What sort of symptoms will gastric cancer manifest as?
Weight loss, early satiety, abdominal pain, potentially UGI bleed
Meckel's Diverticula is the most common cause of:
Lower GI bleed in young populations
Meckel's Diverticulum results in painless bleeding into the stool of kids. Meckel's Diverticulum is diverticulum of the:
Distal small intestine (most commonly the ileum)
The most common causes of LGIB in kids and adults, respectively, are:
Kids: Meckel's Diverticulum
Bleeding due to hemorrhoids is usually associated with:
A bowel movement
Most diverticula are left-sided (in the sigmoid colon), however, most diverticula that bleed are:
Right-sided (ascending colon)
You have a very elderly patient with history of vascular disease. If they are experiencing blood in the stool, you should suspect:
In an unstable patient with hematochezia, immediately perform an:
Immediately perform an EGD in a patient who is:
Unstable and is exhibiting hematochezia
In a stable patient with a possible lower GI bleed, order a:
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