Brainscape's Knowledge GenomeTM

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


See full index

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

4 - Upper And Lower GI Flashcards

1
Q

UGI bleeding above:

A

Ligament of Treitz

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

MCC of UGI

A

Peptic ulcer dz

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

Increased risk for PUD

A

Smoking
ASA
NSAIDs
H. pylori

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

Cause of esophageal varices?

A

Portal HTN

EtOH abuse

Liver dz

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What can masquerade as UGI?

A

ENT bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Unusual but important cause of UGI

A

Aortoenteric fistula 2/2 preexisting aortic graft

Leads to exsanguination via hematemesis and/or hematochezia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Classically, what suggests a UGI source?

A

Coffee-ground emesis and hematemesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Hematemesis following retching suggests:

A

Mallory-Weiss tear

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Associated sxs with UGI bleed

A 
HOTN
Tachycardia
Angina
Syncope
Weakness
Confusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What may occur even in the face of profound hypovolemia?

A

Paradoxical bradycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which findings lead you toward liver dz?

A

Spider angiomas

Palmar erythema

Jaundice

Gynecomastia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Most important test during UGI?

A

Type and cross (in case you need it)

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

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

A

Severe illness (in GI bleed pts)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What study is CI’d in GI bleed?

A

Barium contrast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

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

A

Strong evidence for a UGI source of bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Does a negative nasogastric tube aspirate r/o UGI?

A

Nope

False negatives possible for a number of reasons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Most reliable way to dx UGI bleeding in the ED?

A

Visual inspection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Is NGT CI’d for pts with esophageal varices?

A

Nah.

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

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

A

Varices

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?

A

Last

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?

A

80%

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

A

Slide 51

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?

A

Anoscopy

52
Q

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

A

BUN

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)

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