Gastrointestinal Bleeding

Question 1

most common cause of upper GI bleeding

Answer 1

ulcer disease, but it can also be

caused by: gastritis, esophagitis, duodenitis, cancer, and varices.

Question 2

most common cause of lower GI bleeding

Answer 2

diverticulosis.
but then,
Angiodysplasia (arteriovenous malformation, or AVM)
Polyps or cancer
Inflammatory bowel disease
Hemorrhoids
Upper GI bleeding with rapid transit from high volume

Question 3

most important initial management

for GI bleeding.

Answer 3

Assessing blood pressure

Question 4

Ischemic Colitis CxFx and endoscopy result

Answer 4

left lower quadrant pain, mucosal friability

on scope, and a clear demarcation between ischemic and normal tissue.

Question 5

Orthostasis is defined as:

Answer 5

More than a 10-point rise in pulse when going from lying down to sitting or
standing up
or
Systolic blood pressure drop of 20 points or more when sitting up

Question 6

Percentage of blood loss in these Physical findings
Orthostasis
Pulse >100 per minute
Systolic BP <100 mm Hg

Answer 6

15%–20%
30%
30%

Question 7

Variceal Bleeding Cx Fx

Answer 7

Vomiting blood +/– black stool
Spider angiomata and caput medusa
Splenomegaly
Palmar erythema
Asterixis

Question 8

Variceal Bleeding . First measures, lab work up. Dx

Answer 8

severe bleeding-> first replace fluids. Check hematocrit PLT and coagulation test: PT or INR..

NG tube + aspiration?
BUT If upper endoscopy will be done
anyway, there is a limited role for an
NG tube.

Question 9

Indication for Nuclear
bleeding
scan

Answer 9

Endoscopy unrevealing in a massive acute hemorrhage; lacks

accuracy

Question 10

Indication for Angiography

Answer 10

Specific vessel or site of bleeding needs to be identified prior to
surgery or embolization of the vessel; used only in massive,
nonresponsive bleeding

Question 11

Indication for Capsule

endoscopy

Answer 11

Small bowel bleeding; upper and lower endoscopy do not show

the etiology

Question 12

Indication for CT or MRI

of abdomen

Answer 12

Not useful in GI bleeding

Question 13

Indication for EKG, lactate level

Answer 13

Shows ischemia in severe bleeding

Question 14

Gastrointestinal Bleeding Tx

Answer 14

1.- Fluid replacement 1-2L/h
later endoscopy
IV PPI for upper GI bleeding

Question 15

when to do transfusion

Answer 15

2.- Packed red blood cells if the hematocrit is below 30 in those who are older or suffer from coronary artery disease; NOT in young unless HCT <25

Question 16

when to give Fresh frozen plasma

Answer 16

if the PT or INR is elevated and active bleeding is occurring

Question 17

when to give platelets

Answer 17

if below 50,000 + bleeding

or only if <10-20k

Question 18

variceal bleeding TX

Answer 18

Octreotide (somatostatin) then Endoscopy banding.

if that fails -> TIPS. Transjugular intrahepatic portosystemic shunting

Question 19

Tx if all fails

Answer 19

Qx

Question 20

Esophageal and Gastric Varices next step after bleed control

Answer 20

Propranolol or nadolol is used to prevent subsequent episodes
Antibiotics to prevent SBP (peritonitis) with ascites

Question 21

Sclerotherapy is

Answer 21

never the right answer if banding is technically possible

Question 22

dieulafoy’s lesion. what is it?

Answer 22

nornal anatomic variant that can cause upper GI bleeding. Tortuous arteriola that can be anywhere on the GIT tho is more frequent in gastric wall

Question 23

TIPS stands for

Answer 23

Transjugular intrahepatic portosystemic shunt

Question 24

Boerhaave Sx patho

Answer 24

not a GI bleed but compared to them, transmural tear of esophagus,

Question 25

Boerhaave Sx epidem

Answer 25

whereas mallory weiss es de los weekend warriors, BHSx es de chronic vomiters: anorexia, alcoholics

Question 26

Boerhaave Sx cx fx

Answer 26

febrile, dyspnea, air in the mediastinum that u can hear on xray or subcutaneous, “rice krispies under skin” hamman crunch with each heartbeat

Question 27

Boerhaave Sx dx

Answer 27

first test gastro grafin
then barium, tho gastrografin is less irritating so try to only use gg.
both normal? EGD

Question 28

Boerhaave Sx tx

Answer 28

qx

Question 29

dieulafoy’s lesion patho

Answer 29

normal anatomic variant

artery very close to the mucosal surface so any erosion makes it bleed

Question 30

dieulafoy’s lesion cx fx

Answer 30

painless bleed.

Question 31

dieulafoy’s lesion dx and tx

Answer 31

egd and resection

Question 32

hemorrhoids tx

Answer 32

sits baths, preparation H, hemorrhoidectomy

Question 33

mesenteric ischemia epidem

Answer 33

vasculopath pt, Afib hx or recent angiography

Question 34

mesenteric ischemia cx fx

Answer 34

pain out of proportion of the physical exam
pain right after eating
weight loss

Question 35

mesenteric ischemia dx

Answer 35

angiogram . don’ wait till it bleeds coño.

Question 36

mesenteric ischemia tx

Answer 36

resect death tissue or revascularize

Question 37

ichemic colitis patho

Answer 37

occurs at the watershed areas while hypotensive for any reason the ischemia starts

Question 38

ichemic colitis dx

Answer 38

colonoscopy: shows death tissue

Question 39

AVMs (arteriovenous malformation) are asoc with

Answer 39

aortic stenosis

Question 40

peritonitis important signs

Answer 40

Cullen sign umbilliCULLES
Turner sign youTURNintoyarside
they are signs of retroperitoneal hematoma.

Question 41

early complications of pancreatitis

Answer 41

ARDS
Hypocal
pleural effusion

Question 42

dx and tx of
ARDS
Hypocal
pleural effusion
ascites

Answer 42

xray- intub
Ca level-give ca
pe. xray-
ascitys: US 
in pancreatitis dont tube or drain both of these unless u think it's infected

Question 43

midterm complications of pancreatitis

Answer 43

sepsis at day 6

dx with culture and biopsy WITH CULTURE wich is more important

Question 44

late term complications of pancreatitis, and their treatment

Answer 44

abscess. do ct. . drain
pseudocyst. do ct. <6cm and <6 weeks old. whatch and wait
>6cm>6weeks— DRAIN via endoscopy or percutaneous and Bx.
never open the belly while pancreatitis or its complications