GI Bleed - Rutland

bleeding proximal to ampulla of vater is considered what type of bleed

upper gi bleed

GI bleed distal to terminal ileum is considered

lower gi bleed

four Qs in GI bleed

is there GI bleeding?

what is the magnitude of the bleeding?

is the bleeding, upper, mid or lower GI

is there a spec therapy?

what is the most important aspect in the care of gi bleeding

estimation and replacement of blood loss

don’t tilt if pulse

>120

varices

arterial spurting

visible vessel

ulcers >2cm

posterior duodenal bulb ulcers

endoscopic prognostic indicators

is bleeding UGI

hematemesis

melena

BUN >40

NG lavage showing UGI bleeding

if pt has portal HTN, start

octreotide asap rocky

when is the best time to scope a pat

stable

clear stomach debris

painless upper GI bleed

mucosal tear near GEJ, usually on gastric side

most stop bleeding on its own

Mallory-Weiss tear

ulcers

5mm or larger break in GI mucosa

most H Pylori and NSAIDS

peptic ulcers

90% of duodenal ulcers

h pylori

how does h pylori damage mucosa

production of ammonia, proteases, lipases, phospholipases, mucinases

local immune response

mechanical hemostasis

hemostatic clips

ligation bands

tamponade

develop to decompress portal vein

varices

varices

pharm for variceal bleeding

OCTREOTIDE

inhibits release of glucagon’decreases portal venous pressure and direct vasoconstrictive effect on splanchnic arteriolar smooth muscle

somatostatin analogues

controls bleeding

lowre mortality

fewer complications

fewer sessions

variceal band ligation

last resort bleeding

balloon tamponade

arrest bleeding, buys time

SO much complications, doesn’t prolong survival

large submucosal artery

proximal stomach

intermittent painless massive bleeding

hard to ID

dieulafoy lesion

linear erosion in a hiatal hernia

chronic or acute bleeding

painless

cameron’s lesions

AV malformation

osler weber rendu

ehlers danlos

CREST

AVMs can be assoc with

AVMs most common where

stomach and duodenum

gastric cancer

high risk timing of endoscopy (UGIB)

within 12 hours

hemodynamic instability

ongoing bleed

sus varices

timing of endoscopy for standard UGIB

within 24 hours

low risk UGIB

early discharge

hematochezia most commonly indicates

colonic source

hemorrhoids

diverticular bleeding

vascular ectasia

neoplasm

ischemic colitis

IBD

infxn

radiaiton proctitis

lower GI bleed

acute blood loss

right sided diverticular more likely to bleed bc why

ostia wide

thinner colonic wall

pain

low vol hematochezia

h/o ab vasc surg

estrogen therapy, smoking

hypercoag

large vessel disease rarely found

spont resolution

ischemic colitis

white stripe sign

ischemic colitis

grossly bloody diarrhea

IBD

benign rectoanal disease

hemorrhoids

anal fissures

stercoral ulcers

solitary rectal ulcer syndrome

after EGD and colonscopy, 5% bleeds unexplained still

MIDGI bleed

pillcam view

if they said they bled …

they bled

when in doubt

CALL GASTROENTEROLOGY

primary job in GI bleeds

prevent or treat consequences of blood loss