Treatment
How is upper GI bleed caused by varices treated?
endoscopic banding, stenting
Which presents with fresh blood in the stool
Lower
3 causes of esophageal bleed
- GORD or Barrett's oesophagus = small volumes of bright red blood
- Mallory-Weiss Tear = larger amounts of bright red blood
- oesophageal varices = large volumes of dark red blood (effect of severe liver disease - portal hypertension)
How is upper GI bleed diagnosed?
Endoscopy
What are variceal bleeds?
Bleeding through very dilated veins in the lower third of the oesophagus - dilated veins due to portal hypertension
If the patient's UGI bleed was idiopathic, what should be done for long-term prevention of recurrence?
continue PPI therapy in the long term
Which presents with tarry black stool
Upper
Acute Upper GI bleeding most common cause:
PUD
What is a Blakemore tube
What is a medical device inserted through the nose or mouth and used occasionally in the management of upper gastrointestinal hemorrhage due to esophageal varices
When would you transfuse a patient who had an acute GI bleed who has a Hb > 7
If the patient has hypotension
Time frame that endoscopy should be performed in patients with acute GI bleeds
Within 24 hours once pt is stable
OR
Within 12 hours if higher risk pt
What would NG aspiration produce in a lower GI bleed
Clear fluid
Causes of Peptic Ulcer Disease (PUD):
-H. pylori infection-gram neg rod
-NSAIDS-15-30% will develop
-Family history, genetic predisposition
-Aspirin
-Smoking
Two initial diagnostic test for GI bleed
Endoscopy and colonoscopy
what antibiotic should be given pre-endoscopy and why?
erythromycin IV 30-120 minutes prior to procedure as a prokinetic; improves endoscopic visualization and diagnostic yield
Initial treatment basics for upper GI bleed (i.e. before treating underlying cause)? (3)
High dose of IV PPIs
Transfusion of blood in patients with severe blood loss
Transfusion of platelets in patients with abnormal coagulation screens
Which presents with hyperactive bowel sounds
Upper
5 types of drugs which can cause an acute GI bleed
- NSAIDS
- aspirin
- steroids
- thrombolytics
- anticoagulants
What would a pH strip show in a pt with hemoptysis vs. in a pt with hematemesis
Hemoptysis: alkaline
Hematemesis: acidic
Daily double:
What is the Rockall scoring system used for?
What are the 5 variables it measures?
Used to identify patients at risk of adverse outcomes following an acute upper GI bleed
o Age - above or below 60
o Presence of shock
o Any co-morbidities
o Diagnosed cause of bleed
o Any evidence of bleeding
When is surgery indicated in patients with acute GI bleeds
Acute bleed requiring >6 units of blood within 24 hours
OR
10 total units of blood w/ attempts via scope/angiography failed
Melena indicates that blood has been present in the GI tract for how long
At least 14 hours (as long as 3-5 days)
Which muscle most often connects to both the third and fourth parts of the duodenum, as well as to the duodenojejunal flexure
Ligament of Treitz
Percentage of colonoscopies with complications (e.g. perforation)
approximately 0.35 percent
What drug should be administered to a patient with an acute GI bleed prior to endoscopy
PPI admin-gastric pH of 6 or greater promotes clot formation and decreases re-bleeding
PPIs have a mortality benefit in high risk pts