Chapter 89 Gastrointestinal Emergencies - Incomplete

Question 1

True or false - the hematocrit is an unreliable index of acute blood loss ( in the case of Gi bleed)

Answer 1

True - it may be normal or slightly decreased

Question 2

When should colloidal solutions such as albumin, plasma or hetastarch be used with GI bleed?

Answer 2

Massive continuous blood loss - because in this solution there is risk of shock lung and a loss in plasama oncotic pressure

Question 3

Why is dextran avoided in fluid resuscitation

Answer 3

Can affect platelet function

Question 4

Why are PRBCs better than whole volume blood

Answer 4

Less ammonia, less volume

Question 5

Complications of massive transfusions

Answer 5

Hypercitrinemia , hyperlacticacidemia, hypocalcemia, decreased clotting factors and thrombocytopenia

Question 6

What should you give anyone with Gi bleeding whohas low PT regardless of liver function

Answer 6

5-10 mg vitamin K (subq for non life threatening, IV for life threatening)

Question 7

In what cases should specific causes of an upper GI bleed be found

Answer 7

Active bleeding as documented by NG lavage,
Evidence of severe hemorrhage ( documented Hb <10)
Conditions affecting healing/ clotting e.g. catabolic state or serious chronic disease
Hx of unexplaiend gorss occult bleeding or Fe deficiency anemia
Hx of chronic dyspepsia

Question 8

What is the purpose of gastric lavage?

Answer 8

Confirm level of bleeding and estimate the rate of upper Gi bleed

Question 9

True or false gastric lavage can control GI hemorrhage

Answer 9

False - no evidence to suggest this andif clear this does not exclude a major bleeding cause

Question 10

What should you use to lavage in children

Answer 10

NG sump tube (12 F in small children,m 14- 16 F in older)

Question 11

When there is bright red blood that does not clear with repeated gastric lavage for 5-10 minutes - what does this suggest

Answer 11

Significant or on-going hemorrhage

Question 12

How common is clinically apparent UGI bleeding due to esophageal, gastric and duodenal ulcerations in full term newborns

Answer 12

1% healthy full term newborns

Question 13

true or false MW tears are rare in children

Answer 13

True

Question 14

In what circumstances should baloon tamponade be performed

Answer 14

When patient is unrepsive the pharmacotheraoy ir cannot have EGD in timely fashion

Question 15

True of false the Sengstaken-Blackmore tube has one balloon compared to a Linton tube which has two

Answer 15

False - S-B tube has both gastric and esophageal baloons, Linton only has single lavage gastric tube

Question 16

Major complication risk from S-B tube tamponade

What about death risk?

Answer 16

9-35% - major complication risk

5-20% mortality rate

Question 17

What test can help identify swallowed maternal blood in newborn - how does it work ?

Answer 17

Apt-Downey test - blood from aspirate is placed on filter paper and mixed with 1% NaOH - adult Hb will be reduced to give rusty brown color - fetal Hb will not denature and remain red or pink

Question 18

Massive hematemesis usually without any prodromal symptoms

Answer 18

Dielafoy lesion - due to pinpoint non-ulcerated arterial lesion - usually high in the fundis of the stomach - often due to submucosal artery that has taken a tortuous course and eroded through a mucosal defect

Question 19

True or flase - anal fissures can result due to diarrhea and constipation

Answer 19

True - diarrhea can cause irritation

Constipation is the most common cause