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ISBAR GI bleed Final
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ISBAR GI bleed Final
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ISBAR GI bleed Final,PatientWhat is the technical location of upper GI bleeding? - ANSWER: -ABOVE THE
LIGAMENT OF TREITZ
What is the mortality of upper GI bleeding? What is the prognosis? - ANSWER: -10%
mortality
-80% of cases are SELF-LIMITING, but the rest need urgent endoscopic evaluation
What is the presentation of acute upper gastrointestinal bleeding? - ANSWER: -
HEMATEMESIS
-COFFEE GROUND EMESIS
-MELENA
-HEMATOCHEZIA
-HYPOTENSION
What does hematemesis indicate? - ANSWER: -a sign of upper GI bleeding
-bright red blood in vomitus
What does coffee ground emesis indicate? - ANSWER: -a sign of acute upper GI
bleeding
-results from bleeding that has SLOWED OR STOPPED
-gastric acid then converts the RED HEMOGLOBIN to BROWN HEMATIN
-ex: d/t gastritis (esp erosive), mallory weiss tear, esophageal cancer or lesion - can
bleed temporarily and cause intermittent coffee ground emesis
What does melena indicate? - ANSWER: -a sign of acute upper GI bleeding
-DARK TARRY STOOLS
-requires > 50-100 mL of blood loss
What does hematochezia indicate? - ANSWER: -can be a sign of acute upper GI
bleeding, but USUALLY INDICATES LOWER GI BLEEDING
-if this presents in a pt with upper GI bleeding, the pt will appear SICK
-results in a RAPID TRANSIT OF BLOOD THROUGH THE BOWELS when associated with
upper GI bleeding
-like arterial bleed (duodenal ulcer that has hit an artery, etc)
What does hypotension in upper GI bleeding indicate? - ANSWER: -severe bleeding
What are the causes of upper GI bleeding? - ANSWER: -PEPTIC ULCER DISEASE
-PORTAL HYPERTENSION (esophageal varices)
-MALLORY-WEISS TEAR
-VASCULAR ANOMALIES
-EROSIVE GASTRITIS
-GASTRIC NEOPLASM
, -EROSIVE ESOPHAGITIS
-OTHERS (Aortoenteric fistula, Dieulafoy's lesion)
What is the most common cause of upper GI bleeding? - ANSWER: -PEPTIC ULCER
DISEASE
-accounts for 50% of major upper GI bleeding
How does portal hypertension cause upper GI bleeding? - ANSWER: -2nd most
common cause of upper GI bleeding after PUD
-d/t ESOPHAGEAL VARICES (rarely gastric and duodenal varices) or PORTAL HTN
GASTROPHATHY
-less than 1/3 of pts with portal HTN and varices will develop acute bleeding
-the cases that develop hemorrhages have a 15-40% hospital mortality rate
-mortality rate over the next 1-4 yrs = 60-80%
How does Mallory-Weiss Tears cause upper GI bleeding? - ANSWER: -5-10% of major
upper GI bleeding
-d/t laceration at ESOPHAGEAL JUNCTION w/ stomach d/t history of heavy alcohol
consumption and retching (dry heaving)
How do vascular anomalies cause upper GI bleeding? - ANSWER: -account for 7% of
upper GI bleeding
1) VASCULAR ECTASIAS
2) HEREDITARY HEMORRHAGIC TELANGIECTASIAS
How does erosive gastritis cause upper GI bleeding? - ANSWER: -accounts for <5% of
upper GI bleeding
-COMMONLY RESULTS IN CHRONIC BLOOD LOSS
-due to NSAIDs (ibuprofen, aspirin, etc.), alcohol, or severe medical/surgical illness
What % of upper GI bleeding is d/t gastric neoplasms? - ANSWER: -1% of upper GI
bleeding
How does erosive esophagitis cause upper GI bleeding? - ANSWER: -due to GERD and
often taking medications (like in elderly, nursing home pts)
-a RARE cause of significant upper GI bleeding
What are some other causes of upper GI bleeding? - ANSWER: - AORTOENTERIC
FISTULA
-DIEULAFOY'S LESION (aberrant gastric submucosal artery) - this is an artery in the
stomach that should be deep but for some reason is more superficial, causing it to
intermittently bleed
In general, what are esophageal varices caused by? - ANSWER: -d/t PORTAL
HYPERTENSION
-causes dilated SUBMUCOSAL VEINS
-the most common cause of portal HTN is cirrhosis
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