GI bleed, Ascites, and Peritonitis

Question 1

what ligament is located at the celiac trunk and differentiates between upper and lower GI bleed?

Answer 1

ligament of treitz

Question 2

what symptom indicates a moderate-severe bleed?

Answer 2

hematemesis

Question 3

what symptom indicates limited bleeding that may have already stopped?

Answer 3

coffee-ground emesis

Question 4

black, tarry stools resulting from the digestion of blood that has been moving slowly through the GI tract?

Answer 4

melena

Question 5

_____: bright red blood from the rectum that if due to UGIB, it is indicative of a loss of blood > _____

Answer 5

hematochezia
1000 mL

Question 6

what is the most common cause of an UGIB?

Answer 6

peptic ulcer disease

Question 7

a patient presents with abdominal discomfort, nausea and vomiting bright red blood or coffee-grounds. Dx?

Answer 7

upper GI bleed

Question 8

if anemia is found in a patient with an UGIB, what does this indicate?

Answer 8

chronic blood loss

Question 9

how long does H/H take to reflect blood loss?

Answer 9

2-3 hours

Question 10

what is the initial intervention of choice for diagnostic and treatment capabilities of an upper GI bleed after stabilization?

Answer 10

EGD

Question 11

what are 3 indicators of moderate-severe blood loss requiring stabilization?

Answer 11

SBP < 100
HR > 100
postural hypotension

Question 12

what is the treatment for an UGIB and a LGIB? (3)

Answer 12

admit for EGD
PPIs
antibiotics

Question 13

what treatment is recommended for bleeding esophageal varices?

Answer 13

octreotide

Question 14

where do most LGIB cases originate?

Answer 14

within colon

Question 15

a patient presents with hematochezia from the rectum. Dx?

Answer 15

lower GI bleed

Question 16

what is the most common cause of a LGIB?

Answer 16

diverticulosis

Question 17

what diagnostic can possibly visualize source of bleeding from hemorrhoid or rectal vault in LGIB?

Answer 17

anoscopy

Question 18

what can be used to reduce the bleeding risk for patients at risk for ulcers who are taking NSAIDs long term?

Answer 18

omeprazole (PPI)

Question 19

what should all patients with esophageal varices be taking?

Answer 19

beta blocker

Question 20

what can be used in patients with UGIB or LGIB with contraindications to beta blockers?

Answer 20

preventative esophageal varices ligation (EVL)

Question 21

accumulation of fluid in the peritoneal cavity

Answer 21

ascites

Question 22

what is the most common cause of ascites?

Answer 22

portal hypertension from liver disease

Question 23

a patient presents with increased abdominal girth, abdominal fullness (SOB/early satiety), distended abdomen and a + fluid wave. Dx? Tx (2)?

Answer 23

ascites

spironolactone
paracentesis

Question 24

what can be used to confirm a Dx of ascites?

Answer 24

abdominal US

Question 25

what diagnostic is indicated for initial onset of ascites, patients with cirrhosis for symptomatic relief, or to diagnose bacterial peritonitis?

Answer 25

abdominal paracentesis

Question 26

a patient’s abdominal paracentesis shows clear, yellowish, honey-colored fluid. what does this indicate?

Answer 26

normal

Question 27

a patient’s abdominal paracentesis shows cloudy fluid. what does this indicate?

Answer 27

infection

Question 28

a patient’s abdominal paracentesis shows milky fluid. what does this indicate?

Answer 28

chylous = lymphatic obstruction

Question 29

a patient’s abdominal paracentesis shows bloody fluid. what does this indicate? (2)

Answer 29

traumatic collection
malignancy

Question 30

a patient’s paracentesis lab studies has > 500 WBCs and > 250 PMNs. etiology?

Answer 30

bacterial infection

Question 31

a patient’s paracentesis lab studies has more lymphs than PMNs. etiology? (3)

Answer 31

viral
TB
malignancy

Question 32

what SAAG (serum albumin : ascites albumin gradient) indicates portal hypertension?

Answer 32

SAAD > 1.1

Question 33

what diagnostic can be used to identify a mass?

Answer 33

CT

Question 34

what diagnostic gives direct visualization and biopsy of suspected malignancy?

Answer 34

laparoscopy

Question 35

what treatment can be considered in refractory cases of ascites with a cirrhotic etiology? (2)

Answer 35

transjugular intrahepatic portosystemic shunt (TIPS)
liver transplant

Question 36

infection of the ascitic fluid with no apparent intra-abdominal source of infection

Answer 36

spontaneous bacterial peritonitis (SBP)

Question 37

what are the most common pathogens of spontaneous bacterial peritonitits?

Answer 37

gram negative

Question 38

a patient presents with fever, abdominal pain, ascites, and abdominal tenderness. Dx?

Answer 38

spontaneous bacterial peritonitis

Question 39

what cell count is presumed SBP while pending cultures?

Answer 39

ascites PMN count > 250

Question 40

in which 4 cases would we start empiric therapy in a patient with SBP/ascites?

Answer 40

temp > 100
abdominal pain/tenderness
AMS
PMNs > 250

Question 41

what is the treatment for SBP? (2)

Answer 41

IV cefotaxime/ceftriaxone
IV albumin (improves mortality, protects against renal failure)

Question 42

what should be D/C in patients with SBP?

Answer 42

non-selective beta blockers

Question 43

what should be given to all survivors of SBP? why?

Answer 43

long-term prophylactic antibiotics
recurrence rate is 70%