GI Emergencies Flashcards
What type of GI bleed occurs most often?
Upper GI bleed. (6 times more frequent)
What are peptic ulcers caused by?
Most often caused by H-Pylori NSAID use Alcohol Tobacco Stress Gastritis
What are some symptoms of Peptic Ulcer?
Presents with stomach pain
Upper GI bleed
What type of patient is most susceptible to esophageal varices?
Chronic alcoholism
What are some signs/symptoms of esophageal varices?
Vomiting bright red blood
Bright red diarrhea
Syncope
Altered mental status
What medication aids in the treatment of esophageal varices?
Octreotide, this is a synthetic form of Somatostatin.
It reduces splenic and hepatic blood flow and reduces variceal pressures
What is something to remember with esophageal varices?
DO NOT INSERT NG TUBE
In patient’s with chronic/forceful vomiting, what syndrome of the esophagus may present itself?
Mallory-Weiss syndrome
What is Mallory-Weiss Syndrome?
Rupture of the esophagus
What are the signs/symptoms and treatment for Mallory-Weiss syndrome?
Bloody vomit. Often self resolving but if persistent treat like esophageal varices
How do you define Boerhaave’s tears and what is a sign of it’s presence?
Complete transmural rupture of the lower thoracic esophagus. Presents with shock and chest pain. Hamman’s sign will be present.
What is Hamman’s sign?
Crunching sound upon auscultation of the heart due to pneumomediastinum
What are common lower GI bleeds?
Diverticulitis Hernias Adhesions Inflammatory bowel disease Foreign objects
What are common lab findings in patient’s with GI bleed?
Lower HGB <10
Decrease in hematocrit
Thrombocytopenia
Increase in BUN and WBC
What are common lab findings in patient’s with liver disease?
Increased liver enzymes Decrease in albumin Increase in Bilirubin Increase in BUN and serum ammonia Decrease blood sugar
What primary symptom presents with increased levels of ammonia? What is the treatment?
Increased ICP or Altered level of Consciousness
Treat with Lactulose (removes ammonia)
What is Hepatic Encephalopathy?
The loss of brain function when a damaged liver doesn’t remove toxins from the blood.
What is Asterixis? How can you treat it?
Course “flapping” muscle tremor during voluntary movements.
Lactulose
What is Pancreatitis and what are signs and symptoms?
Digestive enzymes destroy the pancreas. Caused by gallstones or alcohol abuse.
SS: Pain often centered in upper middle or upper left abdomen radiating to back, May have Cullen’s sign or Grey-turner’s sign.
What is SIRS? (Systemic inflammatory response)
Acute inflammation of organ caused by acute infection, trauma or most common, acute pancreatitis.
What are commonly seen in pancreatitis?
ARDS, SIRS atelectasis and pleural effusions, Increased lipase and amylase
What is Grey-Turner’s sign?
Flank ecchymosis caused by hemorrhagic pancreatitis
What is Cullen’s Sign?
Periumbilical ecchymosis
What is the treatment for pancreatitis?
Sometimes treated with enzyme pills to aid with digestion
Morphine, NSAIDS, Ketamine, or demerol used for pain.
Sometimes surgery is required
What are the 3 high priority treatments for septic shock?
Fluid resuscitation
Levophed
Antibiotics
What is the rate of mortality for ruptured AAA?
80%
What is the pharmaceutical treatment for deep vein thrombosis (DVT)?
Lovenox or Coumadin
What causes DVT’s?
Vessel wall injury
Surgery, chemical irritation, inflammation, varicose veins, immobility, venous obstruction
What are some signs/symptoms of DVT?
Aching pain, warm, red swollen
What is Homan’s Sign?
Dorsiflexion of foot and constriction of the calf causing calf pain
What are the 6 “p’s” of arterial occlusion?
Pain (early finding) Pallor (pale skin) Paresthesia (numbness) Poikilothermic (cold blooded) Pulselessness (late finding) Paralysis (Late finding)
