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CDM > Case-GIB > Flashcards

Case-GIB Flashcards

1
Q

What is a med class that predisposes pts to ulcers/UGIB

A

NSAIDS

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2
Q

What BUN:Cr is indicative of a GIB

A

> 30:1

occurs because blood is absorbed as it passes through the small bowel and patients may have decreased renal perfusion. The higher the ratio, the more likely the bleeding is from an UGI source

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3
Q

What would the etiology be if the Cr was >1 (if BUN >30)?

A

Renal

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4
Q

You have a pt whose BUN:Cr is 45:1? What is the etiology?

A

GIB

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5
Q

Normal AST range?

A

0-35IU

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6
Q

Normal ALT range?

A

0-35IU

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7
Q

Normal ALP range?

A

30-120IU

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8
Q

Normal total protein?

A

6-8g/dL

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9
Q

Normal total bili?

A

0-1mg/dL

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10
Q

Normal albumin?

A

3.5-6mg/dL

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11
Q

Normal Ca2+

A

8.5-10

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12
Q

When do you check for corrected Ca2+?

A

If albumin <3.5mg/dL

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13
Q

5 steps for initial GIB management in the ER

A 
1. 2 large bore IVs 
(make pt NPO)
2. Type & Cross
3. 500- 1000cc Fluids 
(while waiting for blood)
4. Blood Transfusion 
(1unit PRBC)
5. find the bleed (call GI for EGD)
***stop the damn NSAIDS
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14
Q

What Hgb do we transfuse at w/o sx?

What Hgb do we transfuse at if pts have sx or cardiac dz?

A

7 or less

8

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15
Q

Ideal Time frame for endoscopy

A

< 12hrs

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16
Q

Classification for Grading GIBs?

A

Forest classification

17
Q

Name the 6 Forest grades (worst to less bad)

A
  1. Active spurting vessel
  2. Oozing (active) vessel
  3. Visible vessel, not bleeding (high risk for bleed)
  4. Adherent Clot
  5. Flat-pigmented spot
  6. Ulcer, clean w/o blood
    (risk for rebleed)
18
Q

Tx options for GIB during EGD?

What can we add to the 2 Tx options?

A

**Clips
**Thermal coagulation (heat)
can add on Epinephrine (constriction of vessel)- NO FINGERS, NOSE, TOES, PENIS

19
Q

You can D/C a GIB if 3 things are present…

A

No comorbids
Hgb NL
Stable VS

20
Q

Every GIB should receive this med class (&dose)!

A

PPI
(pantoprazole/ esomeprazole)

80mg

21
Q

T/F: PPI for GIB can be given PO (acutely)?

A

False! IV only

22
Q

What are the positives of giving a PPI for a GIB (4)?

A

• Suppress gastric acid (increase pH of stomach)
(Up to 36hrs)
• Promote faster healing of ulcer
• Control PUD sx
• Stabilize blood clots /promotes hemostasis
(via higher pH)

23
Q

T/F: H2 blockers/combo PPI & H2 blockers work just as well as a PPI alone (IV)

A

False. not as good

24
Q

How long to continue PPI for GIB? can you do PO after bleed stopped 72hrs?

A

4-12 weeks

yes

25
Q

Education of GIB prevention (3):

Which is an independent risk factor for PUD?

A
  1. Stop smoking
  2. Stop drinking >1drink/d
  3. Stop NSAID use (4x increase of PUD, as well as more refractory ulcers and increased rate of complications like bleeding)
    • Always ask about OTC drugs!!!!!

Smoking is an individual risk factor for GIB

26
Q

DDx for PUD?

A 
Esophagitis (reflux esophagitis)
Mallory Weiss Tear
Esophageal Varices from portal HTN
Upper GI tumor
Angiodyspasia (Varicose Vein in GIT)
27
Q

Etiology in this case?
How did our pt get a GIB?
What else can cause the etiology?

A

PUD
NSAIDS, ETOH, Smoking
-H. pylori

28
Q

T/F: Bx for H.pylori is accurate if taken during an EGD?

A

True, but if bleeding, a (-) result cant r/o H. Pylori

Use urea breath or stool Ag to confirm (-) test

29
Q

What drug can be used to reduce splanchnic blood flow & inhibit gastric acid secretion & useful if EGD not avail for 72hrs?

A

Octreotide (SST)

30
Q

When should a pt go back on ASA after a GIB? What circumstances?

A

After bleeding stopped.

IF Hx of CVA, CAD

31
Q

What Physical Exam is SUPER IMPORTANT for suspected GIB?

32
Q

What part of Hx is super important for GIB?

A

Medications

=NSAIDS

33
Q

What part of Objective is SUPER important for GIB?

34
Q

How do we calculate who is low risk and can be managed as outpatient or discharged early after EGD for GIB?

A

-Glasgow Blatchford Score (GBS) or Rockall score calculate risk

35
Q

Using the risk scores, we can calc who is low risk and can be dc’d early/ managed output.

Which risk score can be calculated before EGD? After EGD?

A 
Glasgow-Blatchford Scale-Calculated before EGD results
Uses:
BUN
Hgb
SBP
pulse
presence of melena
syncope
hepatic Dz, and/or HF.
Rockall-After EGD results
Based on: 
age
presence of shock
comorbidity
Dx
EGD results.
36
Q

T/F:All patients with PUD should undergo testing for H. pylori.

37
Q

When can you switch from IV to PO PPI in GIB from PUD?

A

72hrs after endoscopy (stop bleed)

38
Q

Some Signs of GIB (5)

A 
Slightly pale.
Tachycardic.
Mild generalized abd tender
(+)hemoccult stool
dizzy when standing
39
Q

If a pt needs ASA therapy after a GIB, what Rx should they use as maintenance therapy to reduce risk of ulcer complications/ reoccurrence?

A

PPI
Omeprazole
20mg QD

CDM (16 decks)

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