ACUTE GI BLEEDING

Question 1

What is the incidence of hospital admissions due to acute GI bleeding?

Answer 1

“0.1%”

Question 2

What is the mortality rate of acute GI bleeding?

Answer 2

“5-10%; for <60 y/o: < 1%”

Question 3

What are independent predictors of acute GI bleeding?

Answer 3

“Increasing age

Question 4

What is the function of the alimentary canal?

Answer 4

“Provide nutrients

Question 5

What are the layers of the alimentary canal (inner to outer)?

Answer 5

“Mucosa

Question 6

What is the blood supply of the GI system called?

Answer 6

“Splanchnic circulation”

Question 7

What are the presentations of gastrointestinal bleeding?

Answer 7

“Hematemesis

Question 8

What are the classifications of GI bleeding?

Answer 8

“UGIB and LGIB”

Question 9

Which is more common, UGIB or LGIB?

Answer 9

“UGIB (4x > LGIB)”

Question 10

What is hematemesis associated with?

Answer 10

“UGIB”

Question 11

What is melena?

Answer 11

“Blood in the GIT for at least 14 hours and as long as 3-5 days”

Question 12

What increases the likelihood of melena?

Answer 12

“A more proximal bleeding site”

Question 13

What is hematochezia associated with?

Answer 13

“LGIB”

Question 14

What might bleeding lesions of the small bowel present as?

Answer 14

“Melena or hematochezia”

Question 15

What are clues to UGIB?

Answer 15

“Hyperactive bowel sounds

Question 16

What are UGIB bleeding sources?

Answer 16

“Esophagus

Question 17

What are the two types of UGIB?

Answer 17

“Variceal bleeding and non-variceal bleeding”

Question 18

What is variceal bleeding associated with?

Answer 18

“History of chronic liver disease or cirrhosis”

Question 19

What does liver cirrhosis result in?

Answer 19

“Portal hypertension and porto-systemic anastomosis”

Question 20

What are common sites of portosystemic anastomosis?

Answer 20

“Esophagus

Question 21

What are the steps in the approach to a patient with acute GI bleeding?

Answer 21

“History

Question 22

What symptoms are seen in the history of a patient with acute GI bleeding?

Answer 22

“Abdominal pain

Question 23

What findings are seen in physical examination of acute GI bleeding?

Answer 23

“Weak pulse

Question 24

What are the key laboratory tests in acute GI bleeding?

Answer 24

“CBC

Question 25

What is the initial diagnostic test for UGIB?

Answer 25

“Endoscopy”

Question 26

What is an esophagogastroduodenoscopy (EGD)?

Answer 26

“A safe and accurate outpatient procedure performed under conscious sedation”

Question 27

What imaging studies may be used for GI bleeding?

Answer 27

“CXR

Question 28

What is nasogastric lavage used for?

Answer 28

“Confirm recent bleeding

Question 29

What are the benefits of nasogastric lavage?

Answer 29

“Better visualization during endoscopy

Question 30

What does the Rockall Score predict?

Answer 30

“Risk of adverse outcomes following acute upper GIB”

Question 31

What causes peptic ulcer disease?

Answer 31

“Imbalance between mucosal defense and acid/peptic injury”

Question 32

What is the role of H. Pylori in peptic ulcer disease?

Answer 32

“Urease buffers stomach acid; inhibits antral D cells

Question 33

How do NSAIDs contribute to peptic ulcer disease?

Answer 33

“Compromise mucosal defense mechanisms”