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32 Cards in this Set
- Front
- Back
what is the definition of acute GI bleeding? |
overt bleeding: visible blood. |
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what are the 3 types of overt bleeding associated w/ the GI? describe each one. |
melena- black colored, foul smelling. tar consistency stool |
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how do you define Upper GI bleeding? |
blood loss w/n the intraluminal GI tract btwn esophagus & ligament of treitz. |
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how do you approach a pt w/ an UGI bleed? |
1) prompt stabilization/ resuscitation (make sure they are stable) |
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what is the time frame for an emergent endoscopy?
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12-24 hrs |
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when do you need to protect the airway of a person w/ an UGI bleed? |
when the pt is actively vomiting blood in order to prevent the blood from going into their lungs. |
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what size IV to use to get fluids back into a person who has an upper GI bleed? |
2 large caliber peripheral IVs: 18 gauge or larger.
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what BUN:Cr ration is suggestive of an upper GI bleed? |
30:1 |
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what associated sxs would you see in pts with these varying amounts of blood loss?
1) 500ml 2) 1000ml 3) 2000ml |
1) minimal to no sxs |
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what are the signs & sxs associated w/ acute GI bleed? |
hematemesis, coffee ground emesis, melena, hematochezia, tachycardia, orthostasis, syncope, hypotensive shock, MI, cardiopulmonary arrest. |
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what signs & sxs are associated w/ chronic GI bleed? |
weakness, lethargy, heme + stool and dec iron. |
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if the hemoccult comes back positive, is that considered emergent or non emergent?
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non-emergent
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what is on the DDX of UGIB in the esophagus? |
varices, esophagitis, mallory-weiss tear (& assoc boerhaave syndrome) |
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what is on the DDX of UGIB in the stomach?
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varices, ulcer dz, gastropathy/ gastritis/ AVM, Cameron' lesion (hiatal hernia going in & out of diaphragm --> transient periods of loss of blood flow--. areas of ischemia) and dieulafoy's lesion |
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what is on the DDX of UGIB in the duodenal?
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ulcers, varices, AVM's |
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what is on the DDX of UGIB besides esophagus, gastric & duodenal issues? |
neoplasia &nasal/ pharyngeal trauma |
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what is the standard of care for pt w/ GI bleed? (as far as diagnostics) |
1st endoscopy |
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what pts w/ an UGI bleed will be admitted to the ICU? |
hemodynamic instability, respiratory failure, active bleeding |
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what is the tx for acute management of an UGI bleed? |
IV PPI + urgent endoscopy (12-24 hrs)
*can do clipping on endoscopy to stop bleed** |
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What endoscopic findings indicate that recurrent bleeding is likely?
(clean based ulcer, red spot, & adherent clots are NOT likley!--> can send these pts home) |
Visible vessel or active bleed--> recurrent bleeding likely |
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what is the ideal pH for hemostasis (bleeding to stop)? what helps to achieve this? |
7.4
(ulcer healing best > 4, coagulation > 5.9) |
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what is a mallory-weiss tear? how do you tx it? |
often present w/ prolonged wretching --> esophageal tear d/t wretching. |
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what is the therapy for variceal bleeding? |
-Fluoroquinolones antibiotics reduce short term mortality, *always give if pt has liver dz** -octreotide (dec splanchnic pressure/ dec portal pressure), -endoscopy, -transjugular intrahepatic portosystemic shunt (TIPS) or shunt surgery |
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what is the #1 cause of variceal bleeding? |
cirrhosis... is so add antibiotics to the regimen. |
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what is usually MC organ that causes LGI bleed? what is the MCC of lower GI bleed? 2nd MCC?
*usually presents as hematochezia (stool w/ blood) |
organ: colon |
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what findings are indicative for angiographic embolization? |
rebleeding & severe bleeding |
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when is surgery done on a pt w/ a LGI bleed? |
after gastroenterologist & interventional radiology.
*last resort always* |
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which bleed is closely associated with age upper or lower? |
lower. average age 65-- either diverticulosis or AVM, if pain think ischemic colitis |
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which bleed is closely associated with a high mortality rate? |
lower. recurrent or persistent bleeding KILLS.
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what percentage of lower GI bleeds stop spontaneously? |
80% |
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which bleed is more serious, lower or upper?
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UGI bleed *EMERGENCY!! |
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what is step 1 in the care of an UGI bleed? step 2?
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determine stability then admit to ICU (if necessary) & monitor flow vitals.
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