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Rosens > 26. GIB > Flashcards

26. GIB Flashcards

1
Q

Hematemesis

A

Vomit blood or coffee ground

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2
Q

Melena

A

Black tarry stool

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3
Q

Hematochezia

A

Frank blood per rectum or red or maroon stool

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4
Q

Mortality ugib vs lower

A

10%
4%

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5
Q

Two big RF PUD

A

NSAID
H pylori

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6
Q

Ugib originate proximal to?

A

Ligament of treitz- anchors small bowel at duodenal jejunal flexure

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7
Q

Ddx ugib

A

PUD esophagitis varices
Mw test
Gastritis
Caustic ingestion
Coagulopathy

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8
Q

LGIB Two main category

A

Rectal vs colonic bleed

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9
Q

LGIB ddx

A

Diverticulosis
Ischemic colitis
Postpolypectomy
Hemorrhoids
Malignancy
Meckels
IBD
Angioplasia
Ulcers
Peds- anal fissure, meckel; enteric infection

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10
Q

Shock index

A

Hr/ SBP to guide resuscitation

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11
Q

PUD or gastritis where tender on exam?

A

Luq

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12
Q

Labs for gib

A

CBC
Inr
Urea
Lactate
Cr
Bun to cr >35 90% sp id gib
T and S

ECG as ACS can oftentimes be present

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13
Q

RF fib concomitant ACS

A

Diabetes
Tobacco
Liver cirrhosis
Anemia less than 90
Prior ACS

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14
Q

When to cta in LGIB?

A

Stable and GI consult

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15
Q

Massing gib defn

A

Ongoing bleed with shock index of 0.9 or greater

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16
Q

Glasgow blatchford score what is this?

A

Assess likelihood ugib need intervention and used to predict adm

17
Q

Glasgow blatchford score indicating need endoscopy vs mortality

A

7
5

18
Q

Empiric tx gib

A

Large bore iv
2L crystalloid asap in 30 mins
Blood if massive gib
Plus or minus intubation
Imaging consult

19
Q

Concerning history in a gun

A

Over 500ml lost with symptoms of syncope confusion lightheaded dizzy and weakness
Vascular surgery abdo past
Anticoag
Lact greater than 4
Hbg <100 or decrease > 10 from bl

20
Q

Components of Glasgow blatchford scale

A

Bun
Hemoglobin
SBP
Pulse
Melena
Syncope
hepatic disease
HF

21
Q

PPI in gib

A

80 in then 40 bid

22
Q

When to use octreotide in gib?

A

Concern variceal 50 microgram blood then 50 microgram per hour

Ie hx etoh, prior varies, abnormal liver test, known liver disease

23
Q

What abx for patients with varices?

A

Ceftriaxone

24
Q

Best LR + for UGIB

A

hematemesis 5.7-7
melena hx 5.1-5.9
melane stool on exam 25.0
blood or coffee ground NG 9.6

elevated urea to Cr ratio >30:1

25
Q

Worse mortality rf in ugib

A

lact >2.5
INR >1.5
hemoglobin ?<115

26
Q

Shock index calculation

A

HR/SBP

27
Q

Name the factors of the Glasgow Blatchfod bleeding score

A

hemoglobin
bun
initial sbp
sex
HR >/=100
melena present
recent syncope
hepatic disease hx
cardiac failure

28
Q

mc lgib cause

A

diverticular disease

29
Q

Factors higher mortality in LGIB

A

hd instability
repeated hematochezia
gross blood initial rectal exam
initial hemotcrit <35%?
….

Rosens (59 decks)

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