GI bleed, Ascites, and Peritonitis Flashcards
what ligament is located at the celiac trunk and differentiates between upper and lower GI bleed?
ligament of treitz
what symptom indicates a moderate-severe bleed?
hematemesis
what symptom indicates limited bleeding that may have already stopped?
coffee-ground emesis
black, tarry stools resulting from the digestion of blood that has been moving slowly through the GI tract?
melena
_____: bright red blood from the rectum that if due to UGIB, it is indicative of a loss of blood > _____
hematochezia
1000 mL
what is the most common cause of an UGIB?
peptic ulcer disease
a patient presents with abdominal discomfort, nausea and vomiting bright red blood or coffee-grounds. Dx?
upper GI bleed
if anemia is found in a patient with an UGIB, what does this indicate?
chronic blood loss
how long does H/H take to reflect blood loss?
2-3 hours
what is the initial intervention of choice for diagnostic and treatment capabilities of an upper GI bleed after stabilization?
EGD
what are 3 indicators of moderate-severe blood loss requiring stabilization?
SBP < 100
HR > 100
postural hypotension
what is the treatment for an UGIB and a LGIB? (3)
admit for EGD
PPIs
antibiotics
what treatment is recommended for bleeding esophageal varices?
octreotide
where do most LGIB cases originate?
within colon
a patient presents with hematochezia from the rectum. Dx?
lower GI bleed
what is the most common cause of a LGIB?
diverticulosis
what diagnostic can possibly visualize source of bleeding from hemorrhoid or rectal vault in LGIB?
anoscopy
what can be used to reduce the bleeding risk for patients at risk for ulcers who are taking NSAIDs long term?
omeprazole (PPI)
what should all patients with esophageal varices be taking?
beta blocker
what can be used in patients with UGIB or LGIB with contraindications to beta blockers?
preventative esophageal varices ligation (EVL)
accumulation of fluid in the peritoneal cavity
ascites
what is the most common cause of ascites?
portal hypertension from liver disease
a patient presents with increased abdominal girth, abdominal fullness (SOB/early satiety), distended abdomen and a + fluid wave. Dx? Tx (2)?
ascites
spironolactone
paracentesis
what can be used to confirm a Dx of ascites?
abdominal US
what diagnostic is indicated for initial onset of ascites, patients with cirrhosis for symptomatic relief, or to diagnose bacterial peritonitis?
abdominal paracentesis
a patient’s abdominal paracentesis shows clear, yellowish, honey-colored fluid. what does this indicate?
normal
a patient’s abdominal paracentesis shows cloudy fluid. what does this indicate?
infection
a patient’s abdominal paracentesis shows milky fluid. what does this indicate?
chylous = lymphatic obstruction
a patient’s abdominal paracentesis shows bloody fluid. what does this indicate? (2)
traumatic collection
malignancy
a patient’s paracentesis lab studies has > 500 WBCs and > 250 PMNs. etiology?
bacterial infection
a patient’s paracentesis lab studies has more lymphs than PMNs. etiology? (3)
viral
TB
malignancy
what SAAG (serum albumin : ascites albumin gradient) indicates portal hypertension?
SAAD > 1.1
what diagnostic can be used to identify a mass?
CT
what diagnostic gives direct visualization and biopsy of suspected malignancy?
laparoscopy
what treatment can be considered in refractory cases of ascites with a cirrhotic etiology? (2)
transjugular intrahepatic portosystemic shunt (TIPS)
liver transplant
infection of the ascitic fluid with no apparent intra-abdominal source of infection
spontaneous bacterial peritonitis (SBP)
what are the most common pathogens of spontaneous bacterial peritonitits?
gram negative
a patient presents with fever, abdominal pain, ascites, and abdominal tenderness. Dx?
spontaneous bacterial peritonitis
what cell count is presumed SBP while pending cultures?
ascites PMN count > 250
in which 4 cases would we start empiric therapy in a patient with SBP/ascites?
temp > 100
abdominal pain/tenderness
AMS
PMNs > 250
what is the treatment for SBP? (2)
IV cefotaxime/ceftriaxone
IV albumin (improves mortality, protects against renal failure)
what should be D/C in patients with SBP?
non-selective beta blockers
what should be given to all survivors of SBP? why?
long-term prophylactic antibiotics
recurrence rate is 70%
