Zebra Crossing
This disease is characterized by nosebleeds, AV malfornations causing small bowel GI bleeds, and telangactasias on the lips, hands, and oral mucosa
Hereditary hemorrhagic telangictasia (Osler-Weber-Rendu syndrome)
T or F: Lower GI bleeds are more common, more severe, and has a higher mortality rate than upper GI bleeds
FALSE
Upper GI bleeds are more common, more severe, and has a higher mortality rate than lower GI bleeds
What is the most common cause of UGIB?
Peptic ulcer disease (50% of cases)
How soon should colonoscopy be performed in hemodynamically stable patients with lower GI bleeds,
Within 24 hours of presentation
This intern lived in Germany for 2 years
Chrisitian
Defined as "erosion of an aberrant dilated submucosal blood vessel" that can cause severe upper and lower GI bleeds
Dieulafoy lesion
Requires endoscopic therapy
What is the most common cause of minor LGIB?
Hemorrhoidal bleeding
Usually characterized by small volume bright red blood and usually does not cause hemodynamic instability or significant blood loss
Name two medications that can be given as part of pre-endoscopic care for an UGIB
- IV erythromycin (improves gastric visualization and decreases need for repeat endoscopy)
- IV PPI (decreases high-risk endoscopic stigmata in PUD and may reduce need for endoscopic therapy, does not influence outcomes such as rebleeding or death)
- Octreotide (if variceal hemorrhage is suspected)
- Antibiotics such as ceftriaxone or quinolone (at the time of hospitalization for all patients with cirrhosis with suspected GI bleed)
Name two groups of people at highest risk for angiodysplasias.
- Elderly patients (patients > 60 years old)
- ESRD patients
- patients on anticoagulation therapy
This intern's first celebrity crush was Britney Spears and they still listen to her music all the time
Hosam
What is the name of a lesion caused by erosion of a pancreatic pseudocyst or tumor into a vessel with bleeding into the pancreatic duct?
Hemosuccus pancreaticus
Treatment is mesenteric angiography with coil embolization
Name two of the most common causes of small bowel bleeding in patients <40 years old.
- IBD
- Dieulafoy lesions
- Neoplasia
- Meckel diverticulum
- polyposis syndrome (Peutz-Jeghers, FAP)
T or F: Most Mallory Weiss tears do not require endoscopic treatment.
TRUE
Most MW tears stop bleeding spontaneously.
MW tears are at low risk for rebleeding.
For actively bleeding tears, endoscopic techniques such as injection therapy, thermal devices, or endoclips can be used.
This pathology will cause hematochezia in the setting of bowel obstruction
Intussusception
Intestinal wall ischemia from underlying obstruction
This resident played piano for 6 years and bass clarinet for 4 years, but doesn't remember how to play either :)
Shiva
This cause of upper GI bleed is characterized by a triad of jaundice, biliary colic, and GI bleeding
Hemobilia
Bleeding from the hepatobiliary tract often caused by arteriobiliary fistula from trauma or liver biopsy
Treated with angiography or surgery
Name the two causes with the highest risk of lower GI re-bleeding
Diverticular bleeding (9-47%) and angiodysplasia bleeding (37-64%)
In patients with high risk lesions causing UGIB, how long should IV PPI be maintained after endoscopic treatment?
72 hours
to decrease risk of rebleeding
Twice-daily oral therapy PPI should continue for 2 weeks after
For suspected small bowel bleeding, what is the preferred method of imaging in patients with suspected suspected obstruction or altered anatomy (small-bowel Crohn's, radiation enteritis, prior small-bowel surgery)?
CT enterography or MR enterography
Capsule studies have risk of capsule retention due to obstruction or stricture
Barium based studies are no longer recommended for suspected small-bowel bleeding given poor diagnostic yield
This intern has two passports and was not born in the U.S.
MISHA!!
She was born in the U.K.
What life-threatening condition should be considered in a patient with UGIB who previously had aortic graft surgery?
Aortoenteric fistula
Will present as "herald" bleeding with massive exsanguination
Mortality rate is 50% even with surgical intervention
CT with contrast should be performed before endoscopy or other GI evaluation in these patients
Name 2 or more reasons a second-look endoscopy, push enteroscopy, or colonoscopy would need to be performed in suspected small bowel bleeding
If bleeding source is not identified on initial EGD/colonoscopy and small bowel bleed is suspected, a second look EGD, push enteroscopy, or colonoscopy should be done due to these common clinical factors:
- Fresh blood or clot on initial EGD and/or colonoscopy limiting visualization
- Large hiatal hernia
- History of NSAID use
- Poor colon prep for initial colonoscopy
- Incomplete colonoscopy
In which 3 specific patient groups (high thrombotic risk patients) should you re-anticoagulate with IV heparin or LMWH within 48 hours after hemostasis is achieved?
- mechanical prosthetic mitral valve
- A-fib with prosthetic valve or mitral stenosis
- recurrent venous thromboembolism
In patients in whom warfarin was discontinued due to UGIB, re-anticoagulation with LMWH or unfractionated heparin should be considered within 48 hours after hemostasis is achieved.
Patients with cardiac disease, especially valve disfunction, and patients with LVADs may be at increased risk for GI bleed secondary to ___________ (condition).
Acquired von Willebrand disease
This resident was born in El Paso, TX
Saajan