GI Bleeding and GI emergencies Flashcards
What defines the upper GI tract from the lower GI tract?
the ligament of Treitz
What were some of the big etiologies of GI bleeding?
Peptic ulcer disease
Esophageal Varices
-Mallory weiss tears
When do we give fresh frozen plasma?
When there is a high risk of coagulopathy (INR>1.8)
What should all patients with UGIB undergo within 24 hours of arriving to ED?
Endoscopy
What do you give a PUD patient with gi bleed?
PPI
What do you give a liver patient with a GI bleed?
PPI plus octreotide which reduces splanchnic blood flow and decreases portal pressures
What are the indications for Surgery for PUD?
- uncontrollable bleeding
- perforation
- Obstruction
- Intractable disease
- suspected malgnancy
What are the different types of surgeries that can be done for PUD?
- Antrectomy: eliminates hormonal stimulation from the antrum
- Subtotal gastrectomy: decreased number of parietal cells
- Vagotomy: Truncal vagotomy, highly-selective vagotomy
What do we always do to ppl with esophageal variceal bleed?
admit them to ICU
- do variceal banding to prevent re-bleeding
- ballon tube tampnade (blakemore tube)
What is TIPS
Transvenous intrahepatic portosystemic shunt
Where will lower GI bleeds be?
below or distal to ligament of Treitz
-typically more benign course than UGIB
What is the most common cause of major LGIB?
Diverticulosis
How does ischemic colitis present?
Crampy abdominal pain followed by rectal bleeding and no more abdominal pain, self limited
What are some of the most common causes of Occult GI bleeding?
-neoplasms
-Vascular abnormalities
-Acidic peptic lesions
-infections
-meds
IBD etc…
What is the most common cause of intestinal obstruction for this exam?
Peritoneal adhesions
Tx of intestinal obstruction
NG tube decompression and fluid resuscitiation
Irreducible hernia
cannot be manipulated back into the abdominal cavity
Incarcerated hernia
The contents of the sac are literally inprisoned in the sac of the Hernia
Obstruction hernia
loop of the bowel become non functioning with normal blood supply
Strangulated hernia
cut off the blood supply to the content sac (tender)
What is Toxic Megacolon a complication of?
IBD and C. diff colitis
-high risk of perforation
Tx for toxic megacolon
surgery
If someone has peritonitis, what med do we need to stop if we have been prescribing it for portal HTN during SBP because it increases risk of hepatorenal syndrome?
Stop the beta blockers
In SBP, what organisms are we look for?
Gram (-): E. coli and Klebsiella pneumoniae
Gram (+): Streptococcus pneumoniae , strep viridans, enterococcus
*anaerobic are not associated with SBP
What is the major cause of death in peritonitis?
Hepatorenal syndrome
What will we see if there is a perforation?
Pneumoperitoneum
-free air on xray or CT
In esophageal perforation (like Boerhaave syndrome or VS, what will we see on imaging?
pneumomediastinum
subcutaneous emphysema
Subcutaneous emphysema
air tracking along tissue planes
- painless swelling of tissues
- rice crispy feeling (subcutaneous crepitus)
Appendicitis
- rosvings sign
- McBurney point
- Psoas sign
- obturator sign
- most common abdominal surgical emergency*
Familial mediterranean fever
<20 years old
- episodic bouts of acute peritonitis
- resolves on it’s own
- symptoms resemble surgical peritonitis, patients undergo unnecessary explorative laparotomy (ex lap)
- Colchicine can decrease the frequency and severity of attacks
