GI bleed

Question 1

why is the BUN/Cr ration >36 during upper GI bleed?

Answer 1

urea reabsorbed and Cr not in GI tract
+
pre-renal azotemia from volume depletion

Question 2

What are the top 5 causes of upper GI bleed?

Answer 2

PUD
varices
gastritis/gastropathy
erosive esophagitis
mallory-weiss

Question 3

what are the top 5 causes of lower GI bleed

Answer 3

diverticular hemorrhage
cancer
colitis-infectious, ischemic, IBD
angiodysplasia
anorectal

Question 4

FOBT guaiac? highly sensitive or specific?

Answer 4

sensitive, but not specific

Question 5

does FOBT fit test detect upper and lower bleeds?

Answer 5

no- lower only

Question 6

Iron and pepto-bismal darken the stool but…?

Answer 6

will not yield a false positive on the FOBT test

Question 7

what are some false positive FOBT foods?

Answer 7

red meat, cantaloupe, melons, grapefruit, figs, broccoli, turnips, cauliflower

Question 8

what is the sign of 10% volume loss

Answer 8

tachy

Question 9

what is the sign of 20% volume loss

Answer 9

orthostatic hypotension

Question 10

what is the sign of 30% volume loss

Answer 10

hypotension/shock

Question 11

What labs should we order for GI bleeds

Answer 11

CBC, INR/PT,PTT, BMP, LFT, TYPE AND CROSS

Question 12

How do we treat GI bleed acute

Answer 12

1. assess loss
2. resuscitate- 2 large bore IVs–> NS until stable vitals +normal urine output+ normal mental status
3. transfuse- acute even if Hb>7, Hb50k)
4. ICU if unstable Vitals or end-organ damage

Question 13

What should the initial work up of GI bleed be like?

Answer 13

1. NG tube- fresh blood, coffee grounds, non-bloody bile (Lower bleed)
2. Endoscopy- evaluate for upper and treat upper
3. colonoscopy- do after endoscopy

Question 14

What are our options for unstable/recurrent GI bleed evaluation?

Answer 14

tagged RBC >.1 mL/min- to localize only

arteriography- can localize >.5 and can treat

Question 15

Obscure GIB- ongoing bleeding with negative EGD and colonoscopy should follow what protocol?

Answer 15

repeat EGD with push enteroscopy if it is active
capsule endoscopy
Tc pertechnetate, tagged RBC, arteriography

Question 16

What is the treatment for acute variceal hemorrhage?

Answer 16

1. stabilize
2. octeotride and ceftriazone (SBP prophylaxis)
3. band ligation or TIPS if refraactory

Question 17

What is used for portal hypertension variceal prophylaxis?

Answer 17

propranolol

Question 18

what are non medication treatments for GERD

Answer 18

weight loss, elevate head of bed, don’t eat late, stop smoking

dietary- avoid large fatty meals, coffee, chocolate, peppermint, onions, garlic, EtOH

Question 19

if barretts has no dysplasia…how often do we need EGD?

Answer 19

3-5 years

if low grade 6-12 months

Question 20

what is Rx: for barrett’s low grade vs high grade dysplase?

Answer 20

low- surveillance EGD

high- surgical resection +ablation

Question 21

what can cause false negatives when testing for Hpylori

Answer 21

PPI for urea breath test and stool antigens

Question 22

how do we treat Peptic ulcer

Answer 22

PPI
endoscopy+biopsy
mucosal protection- bismuth

Question 23

What is the triple and quadruple therapy for H. pylori

Answer 23

1. PPI, clarithromycin, amoxicillin

2. PPI, metro, tetra, bismuth