Is it melenic or melanotic?
This is a cause of dark stools without blood.
What is: iron, pepto bismol
This is the management of choice for diagnosis and treatment of lower GI bleeds
What is a colonoscopy.
These are the first things you should think about in evaluating a patient with GI bleed?
What is: the ABCs/CAB- "sick or not sick-" are they stable? BP? HR?
This medicine is usually given when there is concern for a variceal bleed
What is octreotide
This is first line therapy for constipation
fiber and osmotic laxative (miralax and milk of mag)
This is the scoring system that helps determine if patients are more likely to be safe if discharged from the ER.
Glasgow-blatchford score
(BUN, hgb, systolic BP, HR, melena, syncope, cardiac disease, hepatic disease)
Imaging modality of choice for unstable patient with hematochezia.
What is CT-A abdomen/pelvis.
41yoM w/PMHx eHTN, CAD who presents with 3 episodes of melena, found to have Hgb is 10, HR 110s, BP 94/40. Most recent CBC 2 months ago with hgb 13.
sick.
needs IV fluid resuscitation. consider CT-A and talk to GI asap.
True or false: The ACG guidelines recommend PPI therapy prior to endoscopy
False.
4. We could not reach a recommendation for or against preendoscopic PPI therapy for patients with UGIB.
Current evidence does not show a clear benefit.
Specific stool marker that is elevated with an IBD flare
What is fecal calprotectin.
These are 3 causes of melena
What is: PUD, esophageal varices, AVMs, dielufoy lesions, gastritis/esophagitis, medication-induced, mallory-weiss tear
These are 3 causes of hematochezia
What is: colonic polyps, post-polypectomy. diverticular bleed, IBD, malignancy, AVMs, hemorrhoids, infectious, ischemic
80yoM w/PMHx eHTN, A fib on eliquis, HFrEF s/p ICD presents with 2 days of black stools, BP 130/80 with HR 70s. Hgb 7.0 decreased from 2 months ago when it was 11.
What is: stable vs watcher. needs EGD ideally <24 hours
What is primary prevention
Name 3 complications of cirrhotic liver disease.
What is: HE, ascites, varices, coagulopathy/bleeding, hepatorenal
This is the most common cause of an UGI bleed
What is a bleeding ulcer
This percentage of patients with hematochezia actually have an UGI bleed
10-15%
more HDS, prior hx of PUD, more massive bleeding, higher BUN/Cr ratio
Patient w/PMHx AUD, cirrhosis admitted for alcohol withdrawal. You receive a page from the nurse "I think he is coughing up some blood. Can I get an order for tessalon perles."
sick. go see the patient.
This is a medicine typically given 30-60 minutes before an EGD.
What is erythromycin.
erythromycin- prokinetic agent, helps move blood and clot distally and improves visualization at endoscropy, improves diagnostic yield.
This is the most common cause of pancreatitis
What is: gallstones
This is the transfusion threshold for UGI bleed in patients without cardiac disease.
What is a hgb <7.0
recommendations were based on a systematic review indicating that restrictive transfusion policies reduced the number of patients receiving RBC transfusion by 43% with no evidence of an impact on clinically important outcomes. another study comparing restrictive vs. lib showed lower mortality, less cardiac reactions, transfusion reactions, less further bleeding.
Things to consider with abdominal pain and hematochezia.
What is ischemic or inflammatory bowel disease.
At this level of blood volume loss, you see hypotension at rest.
40%
At this INR level endoscopy is generally always considered safe.
INR <2.5
This is why lactulose is given in hepatic encephalopathy
Decreases gut's production of ammonia, decreases pH, and speeds bowel movements so flushes out ammonia.
Bacteria in colon break down lactulose to lactic acid and acetic acid which decreases pH of the gut. Then attaches to ammonia--> charged molecule, cannot cross the gut barrier.
ammonia NH3 turns to ammonium NH4-