aneurysm Flashcards
1
Q
What is a common cause of thoracic aneurysms, especially in older patients?
A
Tertiary syphilis.
2
Q
What type of aneurysm is most commonly associated with connective tissue disorders like Marfan’s and Ehlers-Danlos syndromes?
A
Aortic aneurysms.
3
Q
What is the recommended management for an asymptomatic AAA that is <5.5cm?
A
Monitoring with regular imaging; elective surgery is not typically recommended unless it exceeds 5.5cm or grows >1cm/year.
4
Q
What are common infectious causes of arterial aneurysms?
A
Mycotic aneurysms from endocarditis and infections like tertiary syphilis.
5
Q
What is the most important modifiable risk factor for aneurysm rupture?
A
Smoking.
6
Q
What are common symptoms of an unruptured AAA?
A
Often asymptomatic, but can cause abdominal or back pain.
7
Q
What is the clinical significance of a saphena varix presenting with a cough impulse?
A
It indicates incompetence of the saphenofemoral junction (SFJ).
8
Q
What vascular complication can occur as a result of untreated aortic aneurysms?
A
Rupture, thrombosis, or embolism.
9
Q
In what population is AAA screening most beneficial?
A
Men aged 65 years or older.
10
Q
What surgical complication involves the failure of an endovascular stent graft to fully exclude blood flow from an aneurysm?
A
Endoleak.
11
Q
How does a false aneurysm (pseudoaneurysm) form, and what layer is involved?
A
It forms as a collection of blood in the outer layer (adventitia) of the artery, often following trauma.
12
Q
What vascular test evaluates the competency of venous valves by detecting reflux?
A
Doppler ultrasound.
13
Q
What physical sign indicates severe chronic arterial ischemia upon lowering a limb?
A
Reactive hyperemia (limb becomes flushed red).
14
Q
What is a key diagnostic feature of an aneurysm on physical exam?
A
An expansile, pulsatile mass that expands and contracts.
15
Q
What complication can occur if peripheral arterial disease (PAD) is left untreated?
A
Gangrene or limb loss.
16
Q
What is the recommended management for a symptomatic AAA, regardless of size?
A
Elective surgery is typically indicated.
17
Q
What symptom should not be dismissed as renal colic in a patient with known AAA?
A
Intermittent or continuous abdominal pain radiating to the back or groin.
18
Q
What vascular emergency is indicated by a limb that is pale, pulseless, painful, and cold?
A
Acute limb ischemia.
19
Q
What vascular sign involves the sequential color change from white to pink when a limb is lowered?
A
Buerger’s sign, indicating severe ischemia.
20
Q
What imaging modality is often used to monitor aneurysms in patients undergoing surveillance?
A
Abdominal ultrasound.
21
Q
What defines a true aneurysm?
A
Abnormal dilatation involving all layers of the arterial wall.
22
Q
What defines a false aneurysm (pseudoaneurysm)?
A
Blood collection in the outer layer of the artery (adventitia), communicating with the lumen.
23
Q
What type of aneurysm is typically sac-like in shape?
A
Berry aneurysm.
24
Q
What are the most common sites for arterial aneurysms?
A
Aorta, iliac, femoral, and popliteal arteries.
25
What are the potential complications of untreated arterial aneurysms?
Rupture, thrombosis, embolism, fistulae, and compression of nearby structures.
26
What is the prevalence of AAA in people over the age of 50?
Approximately 3%.
27
What increases the risk of aneurysm rupture in monitored patients?
High blood pressure, smoking, male gender, and a positive family history.
28
What are the key symptoms of a ruptured AAA?
Sudden abdominal pain, collapse, shock, and an expansile abdominal mass.
29
What size defines an abdominal aortic aneurysm (AAA)?
An aorta >3cm across.
30
How should patients with an aneurysm >6cm in size be managed?
Elective surgery due to a higher risk of rupture (~25%/year).
31
What type of aneurysm is more commonly associated with infections like endocarditis?
Mycotic aneurysm.
32
What is the relationship between diabetes and AAA?
Diabetics are less likely to develop AAAs.
33
What condition is associated with aneurysm development due to connective tissue disorders like Marfan syndrome?
Aortic aneurysms.
34
What are the key clinical signs of peripheral arterial disease (PAD) during limb inspection?
Loss of hair, shiny skin, ulcers, gangrene, and cyanosis.
35
What is Buerger’s angle, and what does a low angle suggest?
The angle at which the limb becomes pale; <20° suggests severe ischemia.
36
What does delayed capillary refill (>2s) in the limbs indicate?
Arterial insufficiency.
37
What is a common cause of arterial bruits heard on auscultation?
Arterial stenosis or atherosclerosis.
38
What is the first-line surgical option for large AAAs that cannot be managed conservatively?
Endovascular aneurysm repair (EVAR).
39
What are the potential complications of EVAR?
Endoleak (failure to exclude blood flow to the aneurysm), graft migration, or infection.
40
What is the significance of a positive cough impulse over the saphenofemoral junction (SFJ)?
It indicates venous incompetence, possibly a saphena varix.
41
What is the typical screening protocol for AAA in the UK?
Men aged 65 are invited for one-time ultrasound screening.
42
What are the primary features of peripheral arterial disease (PAD) seen on inspection?
Loss of hair, pallor, shiny or dry/scaly skin, cyanosis, deformed toenails, ulcers, gangrene.
43
Where are arterial ulcers commonly found in peripheral arterial disease (PAD)?
Over pressure points like between the toes or under the heel.
44
What does the presence of cyanosis or gangrene suggest during the inspection of a limb?
Advanced peripheral arterial disease (PAD).
45
What is the significance of finding an expansile pulsatile mass during palpation of the abdomen?
It strongly suggests a ruptured abdominal aortic aneurysm (AAA).
46
How should capillary refill time be interpreted in the context of vascular disease?
A capillary refill time >2 seconds suggests arterial insufficiency.
47
What condition is indicated by the sequential color change from white to pink upon lowering a limb (Buerger's sign)?
Peripheral arterial disease, with reactive hyperemia indicating severe ischemia.
48
What condition might be suggested by delayed return of color during Buerger's test (Buerger's angle <20°)?
Severe limb ischemia.
49
How should you assess the size of the abdominal aorta during a vascular examination?
Palpate gently for any enlargement, but avoid pressing too firmly, especially if an expansile mass is present.
50
In a venous examination, where are ulcers more suggestive of venous disease typically located?
Around the medial malleolus.
51
What does the presence of brown hemosiderin deposits on the lower legs indicate in a venous examination?
Venous hypertension.
52
What does the presence of warm, tender varicosities on palpation suggest?
Potential infection or thrombosis in the varicose veins.
53
What does a positive cough impulse over the saphenofemoral or saphenopopliteal junction suggest?
Incompetence of the venous valves at the saphenofemoral junction (SFJ) or saphenopopliteal junction (SPJ).
54
What finding during the tap test (percussion impulse) indicates venous insufficiency?
A transmitted impulse from the varicose vein to the saphenofemoral junction (SFJ) suggests valve incompetence.
55
What does an audible bruit over varicosities indicate during auscultation?
The presence of an arteriovenous malformation.
56
What should a single "whoosh" sound on Doppler ultrasound indicate in a venous system examination?
Competent venous valves at the level of the probe.
57
What does Trendelenburg's test evaluate in the context of venous disease?
The competence of the saphenofemoral junction (SFJ) valve.
58
What examination is recommended to complete a full venous evaluation?
Abdominal, pelvic (in females), and external genital examination (in males) to rule out any masses that might affect venous return.
59
What are the "5 Ps" that characterize acute limb ischemia, a surgical emergency?
Pale, pulseless, painful, paralysed, paraesthetic, and ‘perishingly cold’.
60
What should be inspected during a peripheral arterial disease (PAD) examination?
Scars, loss of hair, pallor, shiny skin, cyanosis, dry/scaly skin, deformed toenails, ulcers, gangrene, and pressure points (between toes, under heel).
61
How does skin temperature help in diagnosing peripheral arterial disease (PAD)?
Cool skin suggests PAD, with a possible clear level above which the temperature becomes warm.
62
What does a delayed capillary refill (>2 seconds) indicate in the context of peripheral vascular examination?
Arterial insufficiency.
63
How should peripheral pulses be assessed during a vascular exam?
Check if peripheral pulses are palpable; if you can’t count them, you’re not feeling them.
64
What clinical finding suggests a ruptured abdominal aortic aneurysm (AAA) during palpation?
Expansile pulsatile mass in the presence of abdominal symptoms.
65
What does the presence of bruits indicate in the context of arterial auscultation?
Arterial disease, often due to stenosis or turbulence in major arteries like the carotid or abdominal aorta.
66
What is Buerger's angle and what does an angle <20° suggest?
It is the angle at which the limb becomes pale; an angle <20° indicates severe ischemia.
67
What does Buerger's sign indicate when the limb becomes flushed red (reactive hyperemia) upon returning to a dependent position?
Severe peripheral arterial disease.
68
What additional tests complete a peripheral arterial system examination?
Ankle-Brachial Pressure Index (ABPI), Doppler ultrasound, and a neurological examination of the lower limbs.
69
What should be inspected during a venous examination?
Varicosities, ulcers around the medial malleolus (suggesting venous disease), and brown hemosiderin deposits (venous hypertension).
70
What does palpation of warm, tender varicose veins suggest?
Possible infection or thrombosis.
71
What is a saphena varix and how is it identified?
It is an enlarged saphenous vein at the saphenofemoral junction (SFJ) and displays a cough impulse upon palpation.
72
What does a transmitted percussion impulse in the tap test indicate?
Incompetence of superficial valves in the veins.
73
What does the presence of a bruit over varicose veins suggest?
Arteriovenous malformation.
74
How does Doppler ultrasound help in assessing venous disease?
It tests for valve competence; a single ‘whoosh’ indicates normal function at the probe level.
75
What is Trendelenburg's test used to assess?
Competence of the saphenofemoral junction (SFJ) valve.
76
What should be included in a complete venous system examination?
Examination of the abdomen, pelvis in females, and external genitalia in males for masses.
77
What should be considered in all patients with fluctuating consciousness or evolving stroke, especially on anticoagulants?
Subdural haematoma – bleeding from bridging veins between cortex and venous sinuses, accumulating between dura and arachnoid, increasing ICP.
78
What is the most common cause of a subdural haematoma?
Trauma, often forgotten as it can be minor or occur months ago; other causes include increased ICP and dural metastases.
79
What are the risk factors for subdural haematoma?
Falls (epileptics, alcoholics), anticoagulation, elderly (due to brain atrophy making veins more vulnerable).
80
What are the symptoms of subdural haematoma?
Fluctuating consciousness, intellectual slowing, sleepiness, headache, personality change, unsteadiness, seizures.
81
What signs indicate subdural haematoma?
Increased ICP, seizures, late localizing neurological symptoms (unequal pupils, hemiparesis).
82
What are the differentials for subdural haematoma?
Stroke, dementia, CNS masses (e.g., tumours, abscesses).
83
How is subdural haematoma diagnosed?
CT/MRI showing a crescent-shaped blood collection ± midline shift.
84
What is the management approach for subdural haematoma?
Reverse clotting abnormalities, surgical evacuation if >10mm or midline shift >5mm (via craniotomy or burr hole washout), address cause of trauma.
85
What are the clinical features of an extradural (epidural) haematoma?
Lucid interval followed by worsening GCS, headache, vomiting, confusion, hemiparesis, dilated pupil, and deepening coma if untreated.
86
What is the typical cause of an extradural haematoma?
Skull fracture, often temporal or parietal, causing laceration of the middle meningeal artery or vein.
87
What are the risk factors for extradural haematoma?
Traumatic skull fracture, particularly near the temple, and tears in dural venous sinuses.
88
What are the differentials for extradural haematoma?
Epilepsy, carotid dissection, carbon monoxide poisoning.
89
How is extradural haematoma diagnosed?
CT showing biconvex (lens-shaped) haematoma; skull X-ray may show fractures crossing middle meningeal vessels.
90
What is contraindicated in extradural haematoma management?
Lumbar puncture is contraindicated.
91
What is the management approach for extradural haematoma?
Stabilize, transfer to neurosurgical unit for clot evacuation ± vessel ligation, manage ICP (intubation, mannitol IV).
92
What is the prognosis of extradural haematoma?
Excellent if diagnosed and treated early; poor if coma, pupil abnormalities, or decerebrate rigidity are present pre-op.
93
What common symptom is associated with subdural haematomas in the elderly?
Fluctuating level of consciousness, often with subtle cognitive or physical changes.
94
How does brain atrophy affect the risk of subdural haematoma?
Brain atrophy increases vulnerability of bridging veins, making them more susceptible to tearing.
95
What is the characteristic shape of a subdural haematoma on imaging?
Crescent-shaped blood collection over one hemisphere.
96
How can subdural haematoma present without trauma?
It can occur due to increased ICP or dural metastases, not always related to recent or severe trauma.
97
What physical examination finding suggests a significant subdural haematoma?
Significant midline shift on imaging indicates a large or clinically significant haematoma.
98
What imaging feature differentiates subdural haematoma from extradural haematoma?
The sickle shape of subdural haematoma versus the biconvex shape of extradural haematoma.
99
What is a common management strategy for subdural haematoma when surgery is indicated?
Surgical evacuation through craniotomy or burr hole washout, especially if there is significant midline shift or large clot.
100
How does anticoagulation therapy affect the management of a subdural haematoma?
Anticoagulation increases bleeding risk; reversing clotting abnormalities is crucial in management.
101
What is the typical progression of symptoms in an extradural haematoma?
Symptoms may start with a lucid interval followed by rapid deterioration in consciousness and increased ICP signs.
102
How does an extradural haematoma typically evolve after initial injury?
The patient may have a lucid interval followed by rapid worsening, including headache, vomiting, and confusion.
103
What is the main concern in managing a patient with a suspected extradural haematoma?
Immediate stabilization and transfer to a neurosurgical unit for clot evacuation to prevent severe complications or death.
104
What is a key diagnostic imaging feature of an extradural haematoma?
A biconvex (lens-shaped) collection of blood localized between the skull and dura mater.
105
How should a patient with an extradural haematoma be monitored in an emergency setting?
Ensure airway management, ICP control, and prepare for urgent surgical intervention if needed.
106
What are the late signs of deterioration in an extradural haematoma?
Late signs include bradycardia, hypertension, dilated pupil, and deepening coma.
107
What is the importance of recognizing the lucid interval in extradural haematoma cases?
The lucid interval is a key indicator of an extradural haematoma, helping differentiate it from other types of brain injury.
108
Why is lumbar puncture contraindicated in suspected extradural haematoma?
Lumbar puncture can worsen brain herniation by increasing intracranial pressure.
109
What additional assessments are crucial for managing patients with extradural haematoma?
Frequent neurological assessments, blood pressure monitoring, and ICP management.
110
What is a key risk factor for subdural haematoma in elderly patients?
Brain atrophy, which makes bridging veins more vulnerable to tearing.
111
What is a common initial symptom of subdural haematoma in a patient with fluctuating consciousness?
Insidious physical or intellectual slowing, sleepiness, headache, or personality changes.
112
When should subdural haematoma be suspected in a patient with fluctuating consciousness?
Consider subdural haematoma in patients with fluctuating consciousness, especially with a history of minor trauma or anticoagulant use.
113
What is the typical CT/MRI finding in a chronic subdural haematoma?
Crescent-shaped, often hypodense or isodense compared to the surrounding brain tissue, indicating an older bleed.
114
What management steps are crucial for a patient with an extradural haematoma?
Urgent surgical intervention, stabilization, and ICP management, including potential intubation and ventilation.
115
How does an extradural haematoma typically affect the pupils?
The ipsilateral pupil may dilate with continued bleeding, reflecting increased ICP and brainstem compression.
116
What should be monitored in a patient with suspected extradural haematoma?
Monitor for signs of increased ICP, changes in consciousness, pupil abnormalities, and neurological deficits.
117
What is a common cause of extradural haematoma?
Laceration of the middle meningeal artery or vein, often from trauma such as a skull fracture.
118
What is the significance of a biconvex shape in CT imaging for brain trauma?
Indicates an extradural haematoma, localized due to dural attachments to the skull.
119
What additional imaging might be used if CT is inconclusive for haematoma?
MRI can provide more detailed images, particularly useful for detecting chronic or small haematomas.
120
What is a common differential diagnosis for symptoms similar to those of a subdural haematoma?
Stroke, dementia, or CNS masses such as tumors or abscesses.
121
What is the importance of identifying the cause of trauma in subdural haematoma management?
Addressing the cause of trauma (e.g., falls) is important to prevent recurrence and manage underlying issues.
122
How does a subdural haematoma present on physical examination compared to an extradural haematoma?
Subdural haematoma often presents with more diffuse symptoms, while extradural haematoma presents with localized symptoms and a distinct lucid interval.
123
What is a sign of impending severe deterioration in a patient with an extradural haematoma?
Rapid deterioration in consciousness, signs of brainstem compression such as irregular breathing, and severe pupil abnormalities.
124
What is the role of anticoagulant reversal in managing subdural haematoma?
Reversing anticoagulant effects is crucial to prevent further bleeding and complications in patients with subdural haematoma.
125
Why might a subdural haematoma present with personality changes?
Due to the impact of increased ICP on brain function, leading to altered mental status and behavioral changes.
126
What is the typical treatment approach for a small, asymptomatic extradural haematoma?
Small, asymptomatic haematomas may be monitored conservatively, with surgical intervention reserved for significant symptoms or complications.
127
What is haematemesis?
Haematemesis is the vomiting of blood, which may appear bright red or look like coffee grounds.
128
What does melaena indicate?
Melaena indicates upper gastrointestinal bleeding; it refers to black, tarry stools with a characteristic smell of altered blood.
129
What should be included in the initial assessment for upper GI bleeding?
A brief history and physical examination to assess severity, including questions about past GI bleeds, dyspepsia, liver disease, dysphagia, vomiting, weight loss, and checking for signs of chronic liver disease.
130
What signs might indicate severe upper GI bleeding?
Signs include cool/clammy skin, capillary refill time >2s, urine output <0.5mL/kg/h, altered GCS, tachycardia (>100bpm), systolic BP <100mmHg, postural drop >20mmHg, and calculating the Rockall score.
131
What is the initial acute management of upper GI bleeding?
Protect the airway, give high-flow O2, insert 2 large-bore IV cannulae, take blood for FBC, U&E, LFT, clotting, and crossmatch, administer IV fluids, and if deteriorating, give group O Rh-ve blood.
132
What should be monitored during the acute management of upper GI bleeding?
Monitor hourly urine output, organize CXR, ECG, check ABG, consider a CVP line, monitor pulse, BP, and CVP, and arrange an urgent endoscopy.
133
What treatment should be administered if there is a suspicion of variceal bleeding?
Administer terlipressin IV (1–2mg/6h for ≤3d) and initiate broad-spectrum IV antibiotics.
134
What is the role of a Sengstaken–Blakemore tube in upper GI bleeding?
It may be used to compress oesophageal varices in uncontrolled bleeding but should only be placed by experienced personnel.
135
What should be monitored and adjusted in further management after initial treatment?
Re-examine after 4 hours, monitor pulse, BP, CVP, and urine output; transfuse to keep Hb >70g/L, ensure a current group & save sample, check FBC, U&E, LFT, and clotting daily, and keep nil by mouth if high rebleed risk.
136
What is the risk factor for rebleeding in peptic ulcer bleeding?
Posterior duodenal ulcers are at highest risk due to their proximity to the gastroduodenal artery.
137
What is the initial step in resuscitating a patient with upper GI bleeding?
Protect the airway and administer high-flow oxygen.
138
What types of IV fluids should be given to a patient with upper GI bleeding?
Start with IV fluids to restore intravascular volume. If the patient’s condition deteriorates, administer group O Rh-ve blood, avoiding saline if cirrhotic or if varices are present.
139
Why is it important to insert a urinary catheter in upper GI bleeding cases?
To monitor hourly urine output, which helps in assessing the patient’s fluid status and response to resuscitation.
140
What is the purpose of administering IV fluids in the management of upper GI bleeding?
To restore intravascular volume and maintain blood pressure until cross-matched blood is available.
141
How is the severity of bleeding assessed with the Rockall score?
The Rockall score helps predict the risk of mortality from upper GI bleeding by considering factors like age, shock, co-morbidity, and endoscopic findings.
142
What is the importance of performing a cross-matched blood transfusion?
It ensures compatibility and prevents transfusion reactions, which is crucial when significant bleeding has occurred and transfusion is needed.
143
What should be done if endoscopic control of upper GI bleeding fails?
If endoscopic control fails, consider surgery or emergency mesenteric angiography/embolization for continued bleeding. For uncontrolled oesophageal variceal bleeding, use a Sengstaken–Blakemore tube with caution.
144
How often should vital signs be monitored in a patient with upper GI bleeding?
Vital signs, including pulse, BP, and CVP, should be monitored at least hourly until the patient is stable.
145
What laboratory tests are crucial in managing upper GI bleeding?
Essential tests include FBC (Full Blood Count), U&E (Urea and Electrolytes), LFT (Liver Function Tests), clotting studies, and crossmatching blood.
146
What clinical signs may indicate worsening upper GI bleeding?
Signs of worsening include worsening shock, significant drop in GCS, increasing tachycardia, persistent hypotension, and deterioration in urine output.
147
What is the rationale for using terlipressin in suspected variceal bleeding?
Terlipressin is used to reduce portal pressure and control variceal bleeding, thereby decreasing the risk of death by about 34%.
148
Why should a patient be kept nil by mouth in high rebleed risk situations?
Keeping the patient nil by mouth helps prevent further stress on the gastrointestinal tract and reduces the risk of rebleeding until the situation is under control and the endoscopist has assessed the condition.
149
What does a drop in GCS indicate in a patient with upper GI bleeding?
A drop in GCS indicates worsening central nervous system function, potentially due to severe hypovolemia or ongoing bleeding.
150
What role does a CVP line play in the management of upper GI bleeding?
A CVP (Central Venous Pressure) line helps monitor and guide fluid replacement, providing information on cardiac function and fluid status.
151
What are the key indicators for starting urgent endoscopy in upper GI bleeding?
Indicators include continued bleeding despite resuscitation, significant drop in hemoglobin levels, and clinical signs of worsening hemorrhage.
152
What is the significance of assessing the patient’s capillary refill time?
A capillary refill time greater than 2 seconds indicates potential hypovolemia and poor perfusion, which are critical in assessing the severity of bleeding and the effectiveness of resuscitation.
153
How should you manage a patient with a suspected upper GI bleed and hepatic impairment?
Avoid saline if hepatic impairment is present, as it can exacerbate fluid overload. Opt for appropriate fluid resuscitation and closely monitor electrolytes and liver function.
154
What is the purpose of administering broad-spectrum IV antibiotics in upper GI bleeding?
To prevent infections, especially if variceal bleeding is suspected, which can be complicated by infections due to compromised immune response or contamination from the GI tract.
155
What does the presence of melaena indicate in a patient with GI bleeding?
Melaena (black, tarry stools) indicates that the bleeding is from the upper GI tract, as it suggests that blood has been altered by digestive enzymes before passing through the intestines.
156
What are the common signs of chronic liver disease to look for in GI bleeding patients?
Look for signs such as jaundice, ascites, spider angiomas, palmar erythema, and asterixis. These signs can indicate liver dysfunction, which may complicate the bleeding event.
157
Why is it important to calculate and monitor the Rockall score in upper GI bleeding?
The Rockall score helps stratify the risk of mortality and guide the urgency and extent of intervention required based on clinical and endoscopic findings.
158
When is surgical intervention necessary for upper GI bleeding?
Surgery is needed if endoscopic methods fail to control the bleeding, or if there is ongoing hemorrhage that cannot be managed with non-invasive techniques or medication alone.
159
How can you distinguish between upper and lower GI bleeding based on stool color?
Upper GI bleeding typically results in melena (black, tarry stools), while lower GI bleeding often results in bright red blood or clots in the stool.
160
What is the importance of monitoring urine output in the management of upper GI bleeding?
Urine output is an important indicator of renal perfusion and overall fluid balance, helping assess the effectiveness of resuscitation and guide further treatment decisions.
161
What is a Sengstaken-Blakemore tube used for in upper GI bleeding?
The Sengstaken-Blakemore tube is used to compress bleeding varices in the esophagus and stomach in cases of uncontrolled variceal bleeding, but it should only be inserted by experienced personnel.
162
How should you manage fluid resuscitation in a patient with upper GI bleeding and renal impairment?
Use balanced fluids and closely monitor kidney function, adjusting fluid therapy to avoid exacerbating renal impairment while ensuring adequate perfusion.
163
What does a low blood pressure and high heart rate indicate in a bleeding patient?
These signs may indicate hypovolemic shock due to significant blood loss, requiring immediate intervention and fluid resuscitation.
164
What role does an ECG play in the management of upper GI bleeding?
An ECG helps identify any cardiac complications or stress related to the bleeding and resuscitation, as well as assess for arrhythmias that might occur due to hypovolemia or electrolyte imbalances.
165
What should be the initial approach in managing a patient with suspected upper GI bleeding?
Start with airway protection, high-flow oxygen, and large-bore IV cannulae for fluid resuscitation. Assess and monitor vital signs, including blood pressure, heart rate, and urine output.
166
What is the importance of blood gas analysis (ABG) in managing upper GI bleeding?
ABG helps assess the patient’s acid-base balance and oxygenation status, guiding appropriate fluid and electrolyte management.
167
When should you consider administering FFP (fresh frozen plasma) in upper GI bleeding?
Consider FFP if there are significant clotting abnormalities or if the patient has received multiple units of blood and there is evidence of coagulopathy.
168
How does liver disease affect the management of upper GI bleeding?
Liver disease can affect clotting factor production and increase the risk of variceal bleeding, necessitating careful management of coagulopathy and the use of specific treatments such as terlipressin.
169
What are common causes of upper GI bleeding that should be ruled out?
Common causes include peptic ulcer disease, esophageal varices, gastritis, and malignancies. Rule out these conditions through history, physical examination, and appropriate diagnostic tests.
170
How should you monitor a patient’s response to resuscitation in upper GI bleeding?
Monitor vital signs (pulse, BP), urine output, and response to fluids and blood transfusions. Adjust treatment based on ongoing assessments of clinical status and lab results.
171
What are the benefits of using a CVP (central venous pressure) line in GI bleeding management?
A CVP line provides continuous monitoring of central venous pressure, aiding in the assessment of fluid status and guiding fluid resuscitation.
172
When is it appropriate to start broad-spectrum antibiotics in upper GI bleeding?
Start antibiotics if there is a suspicion of infection, particularly in cases of variceal bleeding or in patients with signs of sepsis or hepatic encephalopathy.
173
What are potential complications of using a Sengstaken-Blakemore tube?
Potential complications include esophageal rupture, tracheal injury, aspiration, and difficulty in breathing due to compression of the trachea. It requires careful monitoring and should be used by experienced personnel.
174
What factors influence the decision to perform urgent endoscopy in upper GI bleeding?
Factors include the severity of bleeding, failure of initial medical management, and the need for definitive diagnosis and treatment of bleeding lesions.
175
How does the Rockall score guide treatment in upper GI bleeding?
The Rockall score helps stratify the risk of mortality and guides the need for intensive monitoring, intervention, and potential surgical consultation based on clinical and endoscopic findings.
176
Why is it important to assess and manage comorbidities in patients with upper GI bleeding?
Comorbidities such as cardiovascular or renal disease can affect the management and prognosis of upper GI bleeding, requiring tailored treatment strategies and close monitoring.
177
What are the signs of shock that should be monitored in upper GI bleeding?
Signs include tachycardia, hypotension, cool and clammy skin, prolonged capillary refill time, decreased urine output, and altered mental status.
178
How should you manage a patient with upper GI bleeding who has severe anemia?
Transfuse blood products to maintain hemoglobin levels above 70 g/L, correct any coagulopathy, and ensure adequate fluid resuscitation to stabilize the patient.
179
What is the role of crossmatching blood in the management of upper GI bleeding?
Crossmatching ensures compatibility of blood transfusions, reducing the risk of transfusion reactions and ensuring that the patient receives compatible blood for resuscitation.
