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Senior - Emed 3 > 4 - Upper And Lower GI > Flashcards

4 - Upper And Lower GI Flashcards

1
Q

UGI bleeding above:

A

Ligament of Treitz

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2
Q

MCC of UGI

A

Peptic ulcer dz

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3
Q

Increased risk for PUD

A

Smoking
ASA
NSAIDs
H. pylori

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4
Q

Cause of esophageal varices?

A

Portal HTN

EtOH abuse

Liver dz

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5
Q

Mallory-Weiss Syndrome

A

Longitudinal mucosa tear at the GEJ (weak point)

Due to repeated vomiting followed by bright red hematemesis

Associated with drunks, DKA, chemo

Also, excessive coughing or seizures

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6
Q

What can masquerade as UGI?

A

ENT bleeding

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7
Q

Unusual but important cause of UGI

A

Aortoenteric fistula 2/2 preexisting aortic graft

Leads to exsanguination via hematemesis and/or hematochezia

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8
Q

Classically, what suggests a UGI source?

A

Coffee-ground emesis and hematemesis

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9
Q

Hematemesis following retching suggests:

A

Mallory-Weiss tear

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10
Q

Bright red or maroon rectal bleeding unexpectedly originates from UGI sources how often?

A

Only about 14% of the time

What does this mean? If it’s bright red or maroon, it’s POSSIBLE that its UGI, but less likely

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11
Q

Associated sxs with UGI bleed

A 
HOTN
Tachycardia
Angina
Syncope
Weakness
Confusion
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12
Q

What may occur even in the face of profound hypovolemia?

A

Paradoxical bradycardia

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13
Q

Which findings lead you toward liver dz?

A

Spider angiomas

Palmar erythema

Jaundice

Gynecomastia

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14
Q

Most important test during UGI?

A

Type and cross (in case you need it)

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15
Q

Why is BUN high in acute UGI bleed?

A

Digestion and absorption of Hgb

If lower, doesn’t really have time to break-down or absorb it so not as much elevation

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16
Q

What is a single elevated lactate level a sentinel sign of?

A

Severe illness (in GI bleed pts)

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17
Q

What study is CI’d in GI bleed?

A

Barium contrast

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18
Q

In a patient without hx of hematemesis, a (+) NGT aspirate provides what?

A

Strong evidence for a UGI source of bleeding

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19
Q

Does a negative nasogastric tube aspirate r/o UGI?

A

Nope

False negatives possible for a number of reasons

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20
Q

Most reliable way to dx UGI bleeding in the ED?

A

Visual inspection

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21
Q

Is NGT CI’d for pts with esophageal varices?

A

Nah.

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22
Q

Predictors of worse outcomes for UGI

A 
Older patients
Comorbidities
Red hematemesis
Hematochezia
Red blood on NG aspirate
Hemodynamic instability
Abnormal lab studies

Prior variceal banding, clamping or cauterization of an ulcer bed

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23
Q

Initial management of UGI bleed

A

Stabilize!

Two large-bore IV’s

If unstable, a couple boluses of fluid

Draw blood for type and cross

Aggressively resuscitate PRIOR to intubation

24
Q

Blood transfusion guidelines for UGI bleed

A

If hemoglobin is 7 or less - give blood

If hemoglobin is 9 or less in elderly, give blood

25
Q

When to treat coagulopathy in UGI bleed?

A

If INR is high

Or

platelets less than 50K

Or

Severe bleeding

26
Q

Omeprazole guidance for UGI bleeding

A

80mg IV bolus

27
Q

Octreotide use for what UGI bleeding?

28
Q

ABX for UGI bleeding?

A

Cipro for Cirrhosis

29
Q

Blood transfusions can be life-saving, YET:

A

Liberally transfusing patients with a high H/H threshold can cause harm

In other words, just because someone is bleeding doesn’t mean they need blood products

30
Q

An INR > or equal to ______ is a significant predictor of mortality (in a patient NOT on Warfarin)

A

1.5

Indicates significant clotting and/or bleeding problem

31
Q

TXA in UGI bleeding?

A

No benefit

32
Q

PPI’s in UGI bleeding?

A

Reduce the need for surgery, length of stay in hospital, and signs of bleeding

Bc remember, most UGI bleeds are 2/2 PUD

33
Q

How does octreotide work?

A

Inhibits secretion of gastric acid

Reduces blood flow to gastroduodenal mucosa, causes splanchnic vasoconstriction

34
Q

Diagnostic study of choice for UGI?

A

Endoscopy (EGD)

Allows you to see the source (in most cases) AND administer hemostatic therapy

Do it early (w/in 24hrs of presentation)

If unstable, do it now

35
Q

Where does surgery fall that txt algorithm?

36
Q

LGI bleeding

A

Occurs less often than UGI

Less serious than UGI bleeding

37
Q

The MC source of all bleeding per rectum is:

A

UGI bleeding

38
Q

LGI bleeding more common in?

A

Females and elderly

39
Q

Percentage of LGI bleeding that resolved spontaneously?

40
Q

Painless bleeding?

A

Consider diverticular bleeding 2/2 diverticulosis

41
Q

Features of diverticular bleeding

A

Usually left-sided

Usually self-resolves

Can be massive, but not common

42
Q

Mesenteric ischemia can lead to:

A

Bowel necrosis

Causes include: thrombosis, embolism, etc

43
Q

Ischemic and mesenteric ischemia patients:

A 
Over 60yrs
Afib
CHF
MI
Postprandial abd pain
Unexplained weight loss
44
Q

Study of choice for ischemic and mesenteric ischemia?

A

Angiography

CT is good, too

45
Q

Prognosis for mesenteric ischemia?

A

Terrible - 50% mortality even with aggressive treatment

46
Q

Causes of LGI bleeding

47
Q

The MC source of LGI bleeding?

A

Hemorrhoids

48
Q

Factors associated with shitty outcomes in LGI bleed

A 
Hemodynamic instability
Repeated hematochezia 
Gross blood on initial rectal exam
Initial crit under 35%
Syncope

NONTENDER ABD = PREDICTOR OF SEVERE BLEEDING

ASA or NSAID USE

49
Q

What sxs may suggest malignancy?

A

Weight loss and changes in bowel habits

50
Q

Meds that can increase risk of LGI bleeding

A

Salicylates
NSAIDs
Coumadin

51
Q

Bedside test to check for internal hemorrhoids?

52
Q

Bleeding from a source higher in the GI tract may elevate:

53
Q

Scintigraphy (nuke med)

A

More sensitive than angiography and can localize the site of bleeding at as low a rate as 0.1mL/min

54
Q

Is high res CTA a good test?

A

100% for detecting active or recent bleed

55
Q

Is diarrhea genetic?

A

Or does it just run in my jeans?

Senior - Emed 3 (7 decks)

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