Gastroenterology risk factors CC

Question 1

Choledocholithiasis

Answer 1

Link

Question 2

Risk factors for the development of acute acalculous cholecystitis

Answer 2

• Trauma (especially if >12 units of packed red blood cells transfused or Injury Severity Score >12)
• Recent surgery
• Shock
• Sepsis
• Critical illness (any patient requiring ICU admission)
• Total parenteral nutrition
• Prolonged fasting

Question 3

Factors of predicting poor outcome after acute upper gastrointestinal bleeding

Answer 3

• Age > 65 yrs
• Comorbid medical illnesses (liver disease, COPD, renal failure, coronary artery disease, malignancy)
• Variceal bleeding
• Systolic blood pressure <100 mm Hg at presentation
• Large peptic ulcers >3 cm
• Active bleeding (spurting blood vessel) at endoscopy
• Multiple units of blood transfusion
• Onset of acute bleeding when hospitalized for unrelated illness
• Need for emergency surgery for bleeding control

Question 4

Risk factors for the development of
significant cerebral edema in the setting of liver failure

Answer 4

• Hyperacute presentation,
• Younger individuals (<35 years),
• High-grade HE,
• Serum ammonia >150 µmol/L,
• Presence of systemic inflammatory response syndrome or concurrent infection,
• High Sequential Organ Failure Assessment score
• Requirement for vasopressors or renal replacement therapy

MCQs

Question 5

Liver transplant allograft function

Answer 5

Good factors:

• good mental status,
• hemodynamic stability,
• good urine output,
• bile production (seen intraoperatively),
• correction of coagulopathy,
• improvement in electrolytes, and
• improvement of metabolic acidosis

Poor:

• persistent metabolic acidosis,
• ongoing coagulopathy,
• hemodynamic instability,
• hypocalcemia due to citrate toxicity (especially in the setting of massive transfusion of blood products),
• hypoglycemia,
• hyperkalemia,
• increasing encephalopathy, and
• poor renal function

MCQs

Question 6

Risk factors for the development
of stress ulceration causing clinically important bleeding in critically ill patients

Answer 6

• Respiratory failure requiring ventilation for 48 hours
• The presence of a coagulopathy
• Head injuries (Cushing ulcers)
• Spinal trauma
• Polytrauma
• Major burns (>35% body surface area; Curling ulcers)
• Renal failure
• Hepatic failure
• Severe sepsis
• Shock
• Organ transplantation
• Treatment with high dose steroids
• Previous peptic ulcer disease or upper gastrointestinal bleeding

MCQs