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GI Bleeding - Coggle Diagram
GI Bleeding
Management
ABCs, resucitation (IV access 2 large bore), NPO, fluid re-expansion, CBC, blood products
Initial
Fluid management ( FLuid crystalloids, transfusion), reverse anti-coagulation
Pharmacotheray
PPI
Promotion of clot stability, beofre and aftger endoscopy
Somatostatin
for variceal bleeds, increase splanchnic vasoconstriction
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Endoscopy
Timing
Within 24 hrs (UGI), 8-24 LGI
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Mesenteric Angiography
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Diagnose bleeding site, and can perform therapies such as embolization
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Upper GI Bleed
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Causes
Peptic ulcer disease, Varices, Mallory weiss tears (vomiting), erosions, AV malformations, Tumours, Dieulafoy's lesions
PUD
Indicates risk of rebleeding, and determines whether therapy required
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Presentation
Hematemesis (coffee ground), Melena (passage of black tar stools, Increase bowel movement, hemodynamic symptoms, Hematochezia
Lower GI Bleed
Characteristics
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Less hemodynamically significant, higher Hb, less blood transfusion requirements
Causes
Diverticulosis, Cancers/polyps, Colitis/Polyps, Unknow, angiodysplasia
Diverticulosis
Trauma of vasa recta at neck, dome of diverticulum
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Presentation
Red Blood per rectum, Increased frequency of diarrhea,
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Investigations
BUN/Cr
Intravascular dehyhdration leads to decrease renal perfusion, increase BUN and increase Cr
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Physical Exam
Look for hemodynamic instability, intravascular depletion, etiologies of bleeding, orthostatic changes, any volume status changes