Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PCM IV Final > 1. HYHO: UGIB > Flashcards

1. HYHO: UGIB Flashcards

1
Q

Presentation of a patient with UGI bleed

A
  1. Hematemesis = vomit blood
  2. Coffee ground emesis
  3. Melena (dark stools)
  4. Hematochezia (red/maroon blood in stool)
  5. Anemia
  6. Hypovolemic shock
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How does a patient with hypovolemic shock present?

Why?

A

Cold, clammy, vasoconstriction due to low BV detected by baroreceptor reflex => increase HR, sympathetic stimulation and vasoconstriction of non-essential organs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What symptoms can a person with hypovolemic shock face?

A

1. Orthostatic hypotension

2. Tachycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the landmark that divides a UGIB from a LGIB?

A

Ligament of Trietz (the suspensory l. of the duodenum)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are specific causes of UGIB?

A
  1. Peptic ulcer
  2. Esophageal ulcer
  3. Mallory-Weiss tear
  4. Variceal hemorrhage or portal HTN gastropathy
  5. Cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What specific symptoms indicate: peptic ulcer, esophageal ulcer and Mallory Weiss tear?

A
  1. Peptic ulcer: abdominal pain
  2. Esophageal ulcer: odonyophagia, dysphagia, GE reflux
  3. Mallory-Weiss tear: emesis, retching or coughing BEFORE hematemesis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What aspects of history are important to check in a patient with UGIB?

A
  1. History of GI or nose bleeds
  2. PUD
  3. Esophogeal or gastric variceal bleeding in pts with cirrhosis or chronic alcoholics.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What meds can form peptic ulcers => UGIB?

A
  1. Aspirin
  2. NSAIDS (ibuprofin, naproxen sodium)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What meds can promote bleeding?

A
  1. Antiplatelet drugs (clopidrogel)
  2. Anticoagulants (warfarin)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What patients can alter the presentation in one with a UGIB?

A
  1. Bismuth (pepto-bismol)
  2. Iron
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

PE for UGIB (4)

A
  1. Vital signs
  2. Confusion (=> lack of O2 to brain)
  3. Peripheral vasoconstriction (=> cool extremities and cyanosis)
  4. Signs of liver disease (jaundice, ascites, and caput medusa)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Labs for UGIB (4)

A
  1. CBC w/ diff
  2. Cogulation studies (PT with INR)
  3. Liver enzymes (AST/ALT)
  4. Albumin, BUN and creatinine
  5. Guiac stool testing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

If HB is below _________/__________ low-risk patients/high-risk patients => transfuse

A
  • Low-risk patient => below 7 g/dl
  • High-risk patient => below 9g/dl
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Steps involved in resuscitation of a patient with severe UGIB.

A
  1. *** Focus on circulating volume
  2. Airway and circulation
  3. Obtain urgent consulation and treat
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What should be the INITIAL resuscitation focus in a patient with a UGIB?

A
  • Correct circulating volume (hemodynamic stability)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

If a patient with a UGIB is hemodynamically unstable, what do we do?

A
  1. Give 2 large bore IV access (16-18 gauge) in different limbs
  2. Central line ONLY IF: cannot access peripheral venous circulation or infusion would damage peripheral veins
  3. Replace blood
  4. If no blood => cystalloid fluids. If blood => NS
17
Q

How should airway and circulation be controlled in UGIB? (3)

A
  1. Supplimental O2 and monitor on pulse ox
  2. Intubate to perform endoscopy
  3. Balloon tamponade for bleeding
18
Q

If INR > 1.6, give _____

A
  1. Fresh frozen plasma
  2. Prothrombin complex concentrate
19
Q

If actively bleeding, keep platelets ______

A

> 50,000

20
Q

What should be done in a patient with UGIB to make sure if a transfusion is needed, we do not have to waste time and check blood types against donated blood?

A

Cross and match 2-4 units of blood-PRBC.

21
Q

What procedure can be done to ID source of bleeding?

A
  • EDG (esophagogastroduodenoscopy) = looks at the eso, stomach, and first part of duodenum.
22
Q

How can we visualize and treat esophageal varices?

A

Endoscopy with band ligation

23
Q

When endoscopy with band ligation is combined with _________ => lower risk of rebleeding and mortality

A

Endoscopy + Sclerotherapy (IV injection that irritates the vein => causes it to close)

24
Q

Interventational radiology procedures for UGIB?

A
  1. Trans-arterial embolization
  2. TIPS procedure (tranjugular intrahepatic portosystemic shunt) => reduce portal systemic pressure by shunting blood AWAY from varices
25
Q

When is surgery indicated for UGIB and what types are done?

A
  • Perform surgery when cannot perform TIPS or endoscopy, or not available.
  • Surgeries
    • 1. Surgical resection and vessel ligation
    • 2. Splenorenal shunt
26
Q

Meds for PUD

A

PPI (Omeprazole or esomeprazole 40mg IV BID)

27
Q

Meds for esophogastric variceal bleeding and/or cirrhosis.

A
  1. Prophylactic ABX: 1g Ceftriaxone or 400mg BID of fluoroquinolone.
  2. 50mcg IV bolus and then trip at 50mcg/hr of Octetride (Somatostatin) to shunt blood away from varices.
28
Q
  • DO NOT USE _________ for transfusion, except in RARE and DIRE situations.
  • Treatment of choice for anemia, when if trauma: _____
A
  • Whole blood
  • PRBC + crystalloid fluid
29
Q

OSE for GI system

A
  1. TART and TP for T1-L2 (T5 - 9 = > UGI)
  2. Parasympathetics for UGI (vagus nerve = OA and AA joints)
  3. Chapman points for stomach acidity: Left 5th ICS
  4. Chapman points for stomach peristalsis: Left 6th ICS
30
Q

5 Factor Model for UGIB: Respiratory and Circulation (4)

A
    1. Volume resuscitation w crystalloids and see if transfusion is needed.
    1. Once stable => rib raising
    1. Improve excursion of diaphragm by fucking with phrenic nerve (C3-5)
    1. Indirect MFR to thoracolumbar diaphragm
31
Q

5 Factor Model for UGIB: Metabolic - NRG (4)

A
  1. Endoscopy/surgery to fix bleeding
  2. Take PPI and DQ NSAIDS
  3. Nutritional needs
32
Q

5 Factor Model for UGIB: Biomechanical and behavioral

A
  1. Biomechanical: Fix SD: OA/AA and thoracic spine (T5-9)
  2. Behavioral: stop excess alcohol and smoking.
33
Q

5 Factor Model for UGIB: Neurologic

A
  1. Viscerosomatic findings
  2. Chapmans points
  3. Celiac ganglion
34
Q

When should OMT be done for a UGIB?

A
  • After pt is stabilized and ID treatment of bleeding
35
Q

What 4 things should you remember for a UGIB?

A
  1. Recognize, resuscitate and intubate early
  2. Consult GI, radiology and surgery to dx and tx
  3. Give ABX to patient
36
Q

Pt presents with hematemesis and melena. What is the first thing we do to determine course of action.

A
  1. Determine if the pt is hemodynamically stable or unstable
    1. Stable: upper endoscopy within 24 hours
    2. Unstable: resuscitate, prep for emergency upper endoscopy and consult surgery and or interventional radiology if upper endoscopy cannot be performed.
37
Q
A

PCM IV Final (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions