Gastrointestinal

Question 1

GI Distress v. Acute MI

Answer 1

Use history and EKG, NOT relief of symptoms with nitro, antacids, or GI cocktails (antacid, lidocaine, donnatal/bentyl).

Question 2

Non-Reflux Esophagitis

• Symptoms
• Causes

Answer 2

• Odynophagia
• Infectious, esp. in immunocompromised:
• • Fungal
• • Viral - herpes, CMV
• • Bacterial - lactobaccilus, strep
• • Parasitic
• • Other - radiation, corrosive, pill-induced, systemic disease (Behcet’s, Crohn’s, pemphigus vulgarisms, SJS)

Question 3

Perforated Ulcer Management

Answer 3

• Cardiac monitor (EKG if > 40 yo), pulse ox.
• 2x large bore IVs.
• PE - pelvic & rectal.
• Labs - CBC, electrolytes, BUN, Cr, lipase, type & screen, UA +/– hCG.
• Imaging - CXR / abd L lat decubitus –> free air.

*** NPO!!! Place NG tube. Consult surgery; emergent laparotomy.

Question 4

Upper GI v. Lower GI Bleed

Answer 4

Use NGA of stomach and proximal duodenum to r/o upper GI hemorrhage (return of coffee ground, red-tinges, fresh blood in aspirate).

Note: Upper GI = proximal to ligament of Treitz.

Question 5

Upper GI Hemorrhage Management

Answer 5

• Cardiac monitor (+/– EKG), pulse ox (+ O2 if sat < 93%).
• 2x large bore IVs, start NS IVF prn.
• PE - look for s/s of shock.
• Labs - CBC, coags, electrolytes, BUN, Cr, lipase, type & screen, UA +/– hCG.
• Imaging - CXR to r/o subdiaphragmatic air or pulmonary aspiration.

*** Place NG tube (unless you can examine vomit in ED). (+) Blood. Remove. Bleeding typically self-limited. Admit for observation +/– blood transfusion (Hct 25%). Endoscopy/surgery for continued bleeding.