GI

Question 1

other causes of ileus

Answer 1

retroperitoneal/abdominal hemorrhage or inflammation
intestinal ischemia
electrolyte abnormalities

Question 2

ileus vs. sbo on imaging

Answer 2

• both small and large intestines with ileus

- swelling of stomach

Question 3

portal hypertensive gastropathy

Answer 3

Portal hypertensive gastropathy refers to changes in the mucosa of the stomach in patients with portal hypertension; by far the most common cause of this is cirrhosis of the liver. These changes in the mucosa include friability of the mucosa and the presence of ectatic blood vessels at the surface. Patients with portal hypertensive gastropathy may experience bleeding from the stomach, which may uncommonly manifest itself in vomiting blood or melena; however, portal hypertension may cause several other more common sources of upper gastrointestinal bleeding, such as esophageal varices and gastric varices. On endoscopic evaluation of the stomach, this condition shows a characteristic mosaic or “snake-skin” appearance to the mucosa of the stomach.

Question 4

how do you reduce portal pressure?

Answer 4

Non-selective beta blockers (such as propranolol and nadolol)

Question 5

GI bleeder management

Answer 5

Vital signs at least every 4 hours, initial orthostatic VS
 NPO
 Insert two large bore IV’s (at least 18 gauge)
 Hct: repeat on assessment and every 4 hours
 PTT/PT/INR
 BUN: suggestive of GIB if elevated in absence of renal disease
 Type and cross
 Platelet count
 ECG: especially if history of cardiac disease
 IVF: NS or LR
 Nasogastric tube: lavage until clear, low intermittent suction
 Consult gastroenterology

Question 6

variceal bleed treatment

Answer 6

Octreotide 50 μg IV bolus followed by 50 μg/hr continuous infusion for 48-72 hr, endoscopy, balloon tamponade or TIPS if endoscopy fails

Question 7

management of cirrhotics with UGIB

Answer 7

Start with IV therapy daily (e.g., ceftriaxone) and then transition to oral twice-daily norfloxacin or ciprofloxacin once GI bleeding is stabilized. Treat for a total of 7 days.

Question 8

paracentesis contraindications

Answer 8

• Bowel obstruction or distension

- Significant coagulopathy

Question 9

paracentesis complications

Answer 9

secondary bacterial peritonitis, hemorrhage, abdominal wall hematoma, ascitic fluid leak, bowel perforation, hypotension, renal failure, bladder perforation

Question 10

definition of large bore

Answer 10

18 or greater

Question 11

compensated cirrhosis on exam

Answer 11

jaundice, ascites, variceal hemorrhage, or hepatic encephalopathy.

Question 12

bezoar

Answer 12

mass found trapped in the gastrointestinal system