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GI Final > GI Bleeding and GI emergencies > Flashcards

GI Bleeding and GI emergencies Flashcards

1
Q

What defines the upper GI tract from the lower GI tract?

A

the ligament of Treitz

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2
Q

What were some of the big etiologies of GI bleeding?

A

Peptic ulcer disease
Esophageal Varices
-Mallory weiss tears

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3
Q

When do we give fresh frozen plasma?

A

When there is a high risk of coagulopathy (INR>1.8)

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4
Q

What should all patients with UGIB undergo within 24 hours of arriving to ED?

A

Endoscopy

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5
Q

What do you give a PUD patient with gi bleed?

A

PPI

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6
Q

What do you give a liver patient with a GI bleed?

A

PPI plus octreotide which reduces splanchnic blood flow and decreases portal pressures

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7
Q

What are the indications for Surgery for PUD?

A
  • uncontrollable bleeding
  • perforation
  • Obstruction
  • Intractable disease
  • suspected malgnancy
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8
Q

What are the different types of surgeries that can be done for PUD?

A
  • Antrectomy: eliminates hormonal stimulation from the antrum
  • Subtotal gastrectomy: decreased number of parietal cells
  • Vagotomy: Truncal vagotomy, highly-selective vagotomy
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9
Q

What do we always do to ppl with esophageal variceal bleed?

A

admit them to ICU

  • do variceal banding to prevent re-bleeding
  • ballon tube tampnade (blakemore tube)
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10
Q

What is TIPS

A

Transvenous intrahepatic portosystemic shunt

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11
Q

Where will lower GI bleeds be?

A

below or distal to ligament of Treitz

-typically more benign course than UGIB

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12
Q

What is the most common cause of major LGIB?

A

Diverticulosis

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13
Q

How does ischemic colitis present?

A

Crampy abdominal pain followed by rectal bleeding and no more abdominal pain, self limited

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14
Q

What are some of the most common causes of Occult GI bleeding?

A

-neoplasms
-Vascular abnormalities
-Acidic peptic lesions
-infections
-meds
IBD etc…

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15
Q

What is the most common cause of intestinal obstruction for this exam?

A

Peritoneal adhesions

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16
Q

Tx of intestinal obstruction

A

NG tube decompression and fluid resuscitiation

17
Q

Irreducible hernia

A

cannot be manipulated back into the abdominal cavity

18
Q

Incarcerated hernia

A

The contents of the sac are literally inprisoned in the sac of the Hernia

19
Q

Obstruction hernia

A

loop of the bowel become non functioning with normal blood supply

20
Q

Strangulated hernia

A

cut off the blood supply to the content sac (tender)

21
Q

What is Toxic Megacolon a complication of?

A

IBD and C. diff colitis

-high risk of perforation

22
Q

Tx for toxic megacolon

A

surgery

23
Q

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?

A

Stop the beta blockers

24
Q

In SBP, what organisms are we look for?

A

Gram (-): E. coli and Klebsiella pneumoniae
Gram (+): Streptococcus pneumoniae , strep viridans, enterococcus
*anaerobic are not associated with SBP

25
Q

What is the major cause of death in peritonitis?

A

Hepatorenal syndrome

26
Q

What will we see if there is a perforation?

A

Pneumoperitoneum

-free air on xray or CT

27
Q

In esophageal perforation (like Boerhaave syndrome or VS, what will we see on imaging?

A

pneumomediastinum

subcutaneous emphysema

28
Q

Subcutaneous emphysema

A

air tracking along tissue planes

  • painless swelling of tissues
  • rice crispy feeling (subcutaneous crepitus)
29
Q

Appendicitis

A
  • rosvings sign
  • McBurney point
  • Psoas sign
  • obturator sign
  • most common abdominal surgical emergency*
30
Q

Familial mediterranean fever

A

<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

GI Final (13 decks)

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