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Surgery final (Sabiston) > 46 - Acute hemorrhage (UGIB) > Flashcards

46 - Acute hemorrhage (UGIB) Flashcards

1
Q

The relevant organs when talking about UGIB are: (3)

A

esophagus
stomach
duodenum

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2
Q

Esophageal bleeding can be caused by ___ (__%) or ___ (___%)

A

varices
20-30
esophagitis
5-10

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3
Q

Esophagitis can be caused by: (4)

A

chronic GERD
infections
radiation
IBD

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4
Q

How do we usually treat esophagitis? ___. We can also, in rare cases use ___ with ___ treatment

A

PPI
endoscopy
thermal/electrocoagulation

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5
Q

Gastric bleeding is usually caused by ___ (__%).

A

PUD

30-40

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6
Q

What are the most common reasons for gastric bleeding? (6)

A 
PUD
malignancy
stress gastritis
Mallory Weiss
Dieulafoy's lesion
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7
Q

Gastric bleeding due to malignancy is usually characterized by __ bleeding, beside in the case of ___- where ___ bleeding is also common and surgery should be considered

A

chronic
GIST
acute

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8
Q

The following patients should not be treated with PPI due to risk for stress gastritis: (4)

A

ICU patient
septic shock
sepsis
burn (Curling ulcers)

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9
Q

Mallory Weiss bleeding is an ___ bleeding from the mucosa and submucosa of the ___, caused by repetitive ___- common in alcohol abuse

A

arterial
esophagogastric junction (GEJ)
vomiting

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10
Q

___ % of Mallory Weiss bleeding will resolve ___ and the mucosa heal within __ hours

A

90
spontaneously
72

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11
Q

How would you treat severe Mallory Weiss bleeding? (4)

A

endoscopy + epinephrine/coagulation
angiography embolization
surgery + suturing

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12
Q

What treatment is C/I in Mallory Weiss bleeding?

A

Blakemore tube

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13
Q

What are the common etiologies for PUD? (2)

A

H. Pylori

NSAID

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14
Q

Gastric ulcers tend to ___ more, but duodenum ulcers are more ___

A

bleed

common

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15
Q

Bleeding gastric ulcers -> damage to the ____ artery

A

left gastric (originating from the celiac artery)

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16
Q

Bleeding duodenum ulcers -> damage to the ____ artery

A

gastroduodenal artery (originating common hepatic artery)

17
Q

The clinical presentation of PUD will include __ pain relived post ___ or after taking ___

A

epigastric
prandial
PPI

18
Q

Other clinical presentation of PUD include: (4)

A

dyspepsia
nausea
vomiting
bleeding

19
Q

Which criteria is used to assess the risk for rebleeding in PUD?

A

Forrest classification

20
Q

Name the different classes of the Forrest classification: (6)

A 
Ia - active pulsatile bleeding (high)
Ib - active, non pulsatile bleeding (high)
IIa - nonbleeding visible vessel (high)
IIb - adherent clot (intermediate)
IIc - ulcer with black spot (low)
III - clean nonbleeding ulcer bed (low)
21
Q

Curative endoscopy is recommended in Forrest > ___

A

IIc (IIb-Ia)

22
Q

What other criteria do we use to decide if curative endoscopy is needed? (4)

A

shock
low Hgb
ulcer >2 cm
gastric ulcer

23
Q

What are the common treatment procedures for PUD? (6)

A 
PPI (IV)
H. Pylori eradication
cessation of ulcerogenic drugs (NSAID/SSRI/steroids)
curative endoscopy
curative angiography 
surgery
24
Q

Curative endoscopy include either injecting ___ to the base of the ulcer, ___ of the bleeding vessel, or placing ___

A

injecting adrenaline to the base of the ulcer
ablation
hemoclip

25
Q

In order to rule out malignancy, the PU should be examined with endoscopy ___ weeks post treatment . If the the ulcer is still there, we should obtain ___

A

4

biopsy

26
Q

Varices bleeding is the leading mortality cause in ___ patients (__%)

A

cirrhosis

50

27
Q

___ of patients with cirrhosis will develop portal HTN, ___% will develop varices, ___% of them will bleed.

A

2/3
30
30

28
Q

What is the treatment procedure for varices bleeding? (5)

A 
resuscitation
Abx
octreotide (somatostatin)
curative endoscopy (X2) -sclerotherapy/band ligation 
Blakemore tube
29
Q

What are the 5 ways to achieve a definitive treatment for esophageal treatment?

A 
Drugs (BB + PPI + ligation)
TIPS
portosystemic shunts 
non shunts operation
liver transplantation
30
Q

TIPS=___

A

Transjugular-Intrahepatic-Portosystemic-Shunt

31
Q

What do we do when performing TIPS?

A

connecting the hepatic vein with the portal vein using stent - bypassing the liver

32
Q

What are the C/I for TIPS? (4)

A

HF
polycystic liver
encephalopathy
portal vein thrombosis

Surgery final (Sabiston) (54 decks)

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