Morning Report 10/14/15 Obscure Occult and Overt??

Teaching Pearls:

MKSAP Boards Question Review – Bipap has been shown to decrease mortality, decrease need for intubations, and decrease hospital stay in select patients with COPD exacerbations.

  • Definitions
    • Overt Bleeding – GI bleed that is clinically evident. Hematemesis, hematochezia, melena, etc
    • Occult Bleeding – Slow bleed manifested by iron deficiency anemia and/or positive guiac tests
    • Obscure Bleeding – Evident GI bleed without clear source of bleed despite standard work-up
  • Common etiologies for obscure occult GI bleed
    • Angioectasia
    • Cameron lesions
    • NSAID ulcer
    • Malignancy
  • Common etiologies for obscure overt GI bleed
    • Dieulafoy lesion
    • Meckel’s diverticulum
    • Angioectasia
    • Colonic diverticulum
  • Tachycardia suggests blood loss of 15-30%. Patients develop hypotension once blood loss >30%.
  • If unable to find source with EGD/colo, next step is to perform EGD and/or colonoscopy again as 30-50% can be identified
  • Capsule – can detect lesions without active bleeding. Diagnostic in 50-75% of cases. Only offers diagnostic benefits
  • Tagged RBC scan – good sensitivity but poor specificity. Does not offer therapeutic intervention. Ideal for bleeds 0.1-0.5cc/min.
  • Angiography – best for overt bleeding (>1cc/min), allows for immediate therapy.
  • Chronic Hepatitis B Treatment Goals:
    • Treat HBeAg Positive patients if:
      • ALT>2xULN
      • HBV DNA >20,000IU/ml
    • Treat HBeAg Negative patients if:
      • ALT>2xULN
      • HBV DNA >2,000IU/ml

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