Gastric Dz 3

Question 1

what is considered upper GI

Answer 1

anything above ligament of trietz (LUQ)

Question 2

etiologies of UGIB

Answer 2

PUD
erosions/hemorrhagic gastritis
MW tears

esophageal varicose, gastric carcinoma, other

Question 3

location of the bleed

coffe ground emesis

Answer 3

digested in stomach prior to vomiting

slow bleed

Question 4

location of the bleed BRB small amount

Answer 4

trauma from retching, minimal bleed

Question 5

location of the bleed BRB large amount

Answer 5

pumping blood loss from ulcer

get EGD

Question 6

location of the bleed melena

Answer 6

dark tarry stools

proximal to ligament of Treitz

Question 7

location of the bleed hematokhezia

Answer 7

colonoscopy

red or maroon blood in stool (due to LGIB)

Question 8

GI bleed assessment physical exam

Answer 8

s/s that will indicate location of bleed

look for signs of perforation

Question 9

lab work up GI bleed

Answer 9

CBC
CMP 
PTT
INR 
type and screen 

serial H&H

Question 10

signs of hypovolemia

Answer 10

mild to mod hypovolemia - resting tachycardia

moderate to sig hypovolemia - orthostatic hypotension

severe hypovolemia - supine HotN

Question 11

potential bleeding sources

UGIB

Answer 11

ulcer
varices
MW tear

Question 12

potential bleeding sources

LGIB

Answer 12

diverticula 
AVM 
CA 
rectal source 
IBD

Question 13

medications that can cause bleeding

Answer 13

NSAIDS, bisphospinate, anti-platelet/anticoagulant, steroids

Question 14

comorbid illnesses in GIB

Answer 14

CKD, liver DZ

CAD

Question 15

mallory weiss tear

Answer 15

mucus membrane of lower part of esophagus or upper part of stomach that starts to bleed

Question 16

risk factors of mallory weiss tear

Answer 16

violent and lengthy bouts of retching, coughing, vomiting, increased abdominal pressure

dry heaves after an alcoholic binge

Question 17

mallory weiss tear presentation

Answer 17

hematemesis (smaller amount)

blood stool

epigastric pain

Question 18

mallory weiss tear

diagnosis

Answer 18

history and clinical grounds

bleeding has generally stopped w/anti-emetics when pt presents and doesn’t reoccur

Question 19

test of choice in mallory weiss tear

Answer 19

EGD - esp if bleeding continues

CBC + serial H& H

Question 20

mallory weiss tear prognosis

Answer 20

heals in few days without tx

cirrhosis and coagulopathies make future bleeding more likely to occur

Question 21

pathophysiology of esophageal varices

Answer 21

blood from abdominal viscera is backed up due to portal HTN causes formation of collaterals

diversion of obstructed blood to systemic veins and causes them to engorge

Question 22

diseases that cause portal HTN

Answer 22

pre hepatic (obstructive thrombus in portal vein, splenomegaly)

intra-hepatic (cirrhosis)

post hepatic (RSHF, hepatic vein outflow, obstruction)

Question 23

esophageal varices and bleeding

Answer 23

thin walled varicosities that rupture due to minor trauma and cause massive bleeding

Question 24

symptoms of variceal bleeding

Answer 24

copious painless hematemesis (2/2 to decreased liver function)

melena or less likely hematochezia, possible hemodynamic compromise

Question 25

management of variceal

Answer 25

surgical EGD to clip off varicele

Question 26

BUN and GI bleed

Answer 26

BUN to CR ratio should be used to evaluate acute upper GI bleed will have elevated BUN to Cr ratio due to large amounts of protein absorbed HIGHER ratio = SEVERE bleed

Question 27

tx of active UGIB

Answer 27

volume resuscitation w/crystalloid or colloid solution transfuse if nec. HgB goal >9 reverse anticoagluate PPI infusion or Protonix octreotide

Question 28

UGIB consult and diagnostics

Answer 28

GI consult (keep NPO) Endoscopy with 24hrs

Question 29

how to evaluate occult GI bleed

Answer 29

stool guaiac testing

Question 30

Zollinger-Ellison syndrome

Answer 30

gastrin-secreting tumor that stimulates stomach to secrete more acid GI mucosal ulceration, malabsorption and diarrhea

Question 31

cause of ZES

Answer 31

sporadic (MC) multiple endocrine neoplasia type 1 (MEN1)

Question 32

best single screening test of ZES

Answer 32

fasting serum gastrin then localize via imaging studies

Question 33

gastroparesis

Answer 33

delayed gastric emptying without obstruction early satiety, bloating, n/v, anorexia, malnutrition, weight loss

Question 34

MC cause of gastroparesis

Answer 34

DM neuropathy of autonomic and enteric nerve

Question 35

Test OC gastric emptying

Answer 35

gastric emptying study must be suspected on clinical grounds in right patient population

Question 36

tx of gastroparesis

Answer 36

avoid meds that slow gastric emptying (narcotics, anticholinergics, TCA) encourage liquids and blender food high fat, high fiber pro kinetic agents

Question 37

pharmacological agents that can cause n/v

Answer 37

``` chemotherapy analgesics ABX OC metformin ``` HTN meds, seizure meds, Parkinson meds

Question 38

steps in n/v tx

Answer 38

identify and tx underlying cause replace GI fluid and electrolyte losses provide symptom relief preventative measures

Question 39

``` brand + class Ondansetron ```

Answer 39

zofran | 5HT3 Antagonists

Question 40

``` brand + class aprepitant/fosprepitant ```

Answer 40

Neurokinin R Agonists Emend

Question 41

dipenhydramine | brand + class

Answer 41

benedryl antihistamine

Question 42

``` brand + class hydroxyzine ```

Answer 42

Vistaril | antihistamine

Question 43

``` brand + class Promethazine ```

Answer 43

Phenergan | antihistamine

Question 44

``` brand + class scopolamine ```

Answer 44

transform scop | anti-cholinergic agent

Question 45

``` brand + class procholorperazine ```

Answer 45

compazine

Question 46

``` brand + class chloropromazine ```

Answer 46

thorazine

Question 47

metoclopramide brand + class

Answer 47

reglan dopamine receptor agent

Question 48

``` brand + class dronabinol ```

Answer 48

Marinol | cannabinoids

Question 49

5HT3 Antagonists

Answer 49

best used in chemo agents and post operative n/v can cause QT prolongation

Question 50

neurokinin receptor agonists

Answer 50

chemotherapy induced emesis prevents delayed and acute emesis additive therapy in treatment caution in CKD

Question 51

drug interactions with neuokinin

Answer 51

decreased concentration of Warfarin and contraceptives increased concentrations of benzos