GI Emergencies

Question 1

most common GI emergency

Answer 1

acute upper GI bleed

Question 2

most common causes of upper GI bleed

Answer 2

peptic ulcer disease
varices

Question 3

how are variceal bleeds treated in terms of blood transfusion

Answer 3

with restrictive transfusion
don’t want to overload body and cause another bleed

Question 4

investigation of variceal bleed

Answer 4

endoscopy

Question 5

oesophageal varices treatment

Answer 5

banding ligation

Question 6

gastric varices treatment

Answer 6

histoacryl or thrombin injection

Question 7

where can peptic ulcers be found

Answer 7

oesophagus
stomach
duodenum

Question 8

how are ulcers different to erosions

Answer 8

erosions are more superficial

Question 9

what layer of the wall do ulcers penetrate to

Answer 9

muscularis mucosae

Question 10

are peptic ulcers acute or chornic

Answer 10

can be either

Question 11

what is perforation

Answer 11

when the ulcer is very deep and erodes through the submucosa and makes a hole through to peritoneum

Question 12

main causes of peptic ulcer disease

Answer 12

h.pylori
NSAIDs

Question 13

who’s more at risk of h.pylori infection

Answer 13

low SES
older
Eastern europe and asia

Question 14

why should h.pylori be eridicated if found

Answer 14

it can cause cancer

Question 15

how do NSAIDs cause peptic ulcers

Answer 15

impair prostaglandin synthesis in mucosa which results in mucosal injury

Question 16

symptoms of perforation of peptic ulcer

Answer 16

peritonitis
shock
sudden severe pain
shoulder tip pain
air under diaphragm

Question 17

signs of bleeding from peptic ulcer

Answer 17

haematemesis
melaena

Question 18

what vessels are commonly eroded due to peptic ulcers

Answer 18

supraduodenal
gastroduodenal

Question 19

what score is used to assess severity of bleeding

Answer 19

rockall score

Question 20

how is the need for blood transfusion in upper GI bleed determined

Answer 20

depends on underlying condition
haemodynamic status
markers of tissue hypoxia

Question 21

when and where should endoscopy be performed for UGIB

Answer 21

within 6-24h when patient is stable
in critical care environment with anaesthetic support

Question 22

why are PPIs given in UGIB

Answer 22

need a pH > 6 to stabilise clots in the stomach so given a large dose of PPI to neutralise acid

Question 23

what should be checked for in UGIB and what should be done about it

Answer 23

h.pylori
eradication

Question 24

what drug should be stopped after UGIB

Answer 24

NSAIDs

Question 25

indication for surgery after GI bleed

Answer 25

failure to control bleeding

Question 26

describe pain of acute pancreatitis

Answer 26

acute epigastric pain
colicy or continuous pain

Question 27

symptoms of acute pancreatitis in addition ot pain

Answer 27

nausea
vomiting
collapse
hypotension
fever
tachycardia
obstructive jaundice

Question 28

common causes of acute pancreatitis

Answer 28

alcohol
gallstones
post ERCP (after trying to remove gallstones)

Question 29

what blood tests detect acute pancreatitis

Answer 29

> 3x normal amylase or lipase

(made by pancreas and spilled into blood)

Question 30

differential diagnosis of acute pancreatitis

Answer 30

perforated ulcer
ischaemic bowel
abdominal aortic dissection
biliary colic

Question 31

initial management of pancreatitis

Answer 31

high flow oxygen
painkillers
nil by mouth
IV fluids

Question 32

complications of pancreatitis

Answer 32

hypocalcaemia
hypoxia
paralytic ileus
hypovolaemia
renal failure