GI Emergencies

Question 1

An elevated lactic acid level (lactate) indicates your body has a low level of this?

Answer 1

Oxygen

Question 2

What labs should be drawn in a GI emergency?

Answer 2

CBC with diff (for infection)
BMP (Or CMP if RUQ px suggesting liver etiology)
Lipase
UA
hCG
Lactate

Question 3

A patient presents with diffuse, progressively worsening abdominal pain, with decreased PO intake, a HX of hypertension and a recent cholecystectomy. What is the likely DX, what will be seen on imaging, and what is the treatment?

Answer 3

DX: intestinal obstruction
Imaging: shows distended bowel
TX: watch PT to see if resolves on own

Question 4

PT presents with sudden onset lower right quadrant abdominal pain that started in the periumbilical region; what is the likely dx, exam findings, pertinent lab findings, and tx?

Answer 4

Appendicitis

Exam show rebound tenderness

Imaging will show fat stranding and wall thickening of the appendix

TX is removal, pain management, & 3rd generation cephalosporin & metronidazole

Question 5

A patient presents with Fever, anorexia, diarrhea; N/V, dysuria. Physical exam reveals left lower quadrant tenderness, but no rebounding . What is the likely dx, imaging sign, and tx?

Answer 5

Diverticulitis
See fat stranding in bowel
TX is pain control and bowel rest (light liquid diet)

Question 6

What is the drug you should not prescribe in a case of diverticulitis and why?

Answer 6

ABX because it can cause more GI upset, worsen the diverticulitis sx, and cause a possible perforation

Question 7

Patient presents after attending a BBQ 8H ago with RUQ pain 8/10, N/V; the pain is made worse with eating, and PE reveals a positive Murphy’s sign. What is the dx, imaging, CBC finding, and treatment?

Answer 7

Acute cholecystitis

Imaging shows sludge in gallbladder

CBC shows leukocytosis with left shift

TX is ABX and cholecystectomy

Question 8

A patient reports to the ED with tearing midline pain that radiates to their back, what is the likely dx, where is their BP likely to be trending, and what is the tx?

Answer 8

Ruptured aortic aneurysm

BP will be falling bc they are bleeding internally at a very fast pace

only tx is surgical repair

Question 9

A patient presents to the ED with 10/10 epigastric pain that radiates to their back and is made worse by eating. What is the likely dx, LFT & lipase level, and what is the tx?

Answer 9

Acute pancreatitis

LFT and lipase elevated

Administer fluids, pain medication, and send home if uncomplicated

Question 10

What are two DD for melana?

Answer 10

Peptic ulcer disease & esophageal varices

Question 11

What are the DD for hematochezia?

Answer 11

hemorrhoid’s, cancer, IBS

Question 12

Upper GI bleeds originate from what area?

Answer 12

from the esophagus to the ligament of Treitz

Question 13

Lower GI bleeds originate from what areas?

Answer 13

Everywhere below ligament of Treitz

Question 14

What are the common signs of an upper GI bleed?

Answer 14

Vomiting bright red or coffee ground blood, or dark blood in stool

Question 15

What is the common sign of a lower GI bleed?

Answer 15

hematochezia or bright red blood in stool

Question 16

A patient presents with the complaint of coughing up blood, dark tarry stool and heartburn. What is the likely dx?

Answer 16

Esophageal varices; upper GI bleed

Question 17

This is the most common cause of a lower gi bleed?

Answer 17

diverticula bleed

Question 18

What is the emergency protocol of a GI bleed presenting to the ED (4 steps)?

Answer 18

1. ABC
2. 2 large bore IV’s
3. Get emergency blood products ready
4. medication reversal if PT is on anticoagulant/platelet

Question 19

This condition presents with difficulty swallowing; choking, coughing, regurgitation from nose?

Answer 19

dysphagia

Question 20

This condition presents with a feeling that something is stuck in throat; burning with swallowing, and possibly recent doxycycline use?

Answer 20

esophagitis

Question 21

This cause of diarrhea presents with high fever, vomiting, diffuse colicky abdominal pain followed by bloody mucoid diarrhea, and tenesmus?

Answer 21

Shigella - infectious cause

Question 22

What signs are indication that diarrhea needs to be worked further in the ED?

Answer 22

• hypovolemia
• severe ABD px
• fever
• Diarrhea >3days
• blood or pus in stool
• recent ABX use

Question 23

What is the acute management for N/V in the ED?

Answer 23

• Give IV fluids
• give antiemetics
• electrolyte replacement

Question 24

DD for LUQ pain?

Answer 24

Peptic ulcer; gastritis; Spleen stuff