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GI Emergencies Flashcards

1
Q

***Rule of thumb for (packed RBC) blood transfusion and amt Hb raised

A

each unit of blood raises Hb by 1-1.5g

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2
Q

At what Hb level should you ALWAYS transfuse?

A

if Hb less than 7

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3
Q

If hypOtensive or has CV (angina/CAD) disease, keep Hb at what level?

A

Hb 9-10g

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4
Q

LGIB - location and physical description

A

Distal to ligament of Treitz

-BRBPR (hematochezia)

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5
Q

Anion gap equation

A

(Na+) - (Cl- + HCO3-) = 12-16

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6
Q

High Anion gap due to…

A

MUDPILES - hypOperfusing muscles, so your body does lactic acidosis

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7
Q

What is diverticulosis, what location most common

A
  • Herniation of (sub)/mucosa thru muscle layers of colon.

- Left colon most common location

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8
Q

PAINLESS, copious hematochezia or maroon stools is most likely caused by what?

A

diverticulosis

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9
Q

NSAIDs/ASA increase risk of developing…?

A
  • 1-3x risk of diverticular bleed with NSAIDs/ASA
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10
Q

Tx of diverticulosis is?

A

endo-clipping

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11
Q

What is abdominal cramping, bloody diarrhea in a 50+yo?

A

Colitis - seen in ischemic colitis/IBD/infection

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12
Q

Ischemic colitis is associated with…

A

atherosclerosis

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13
Q

**4 causes of 80% of UGIB

A
  1. PUD (gastric or duodenal) - 40-50%
  2. Esophageal or gastric varices
  3. Erosive Esophagitis-gastritis
  4. Mallory Weiss Tear (5-10%)
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14
Q

**4 causes of 80% of LGIB

A
  1. Diverticulosis (30%)
  2. Colitis (24%) - includes ischemic, IBD, radiation
  3. Hemorrhoids - 14%
  4. Post polypectomy bleed - 8%
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15
Q

***Retching and dry heaves due to alcohol or vigorous coughing - what possibly results?

A

Mallory Weiss tear - NONtransmural tear of GE junction

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16
Q

**UGIB treatment

A

IV fluids

**Type/Cross match for packed RBCs TRANSFUSION

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17
Q

**How much blood is transfused for UGIB treatment?

A

2-6 units.

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18
Q

**Approximately how much does one unit of blood raise Hb? What is the ideal platelet count?

A

1-1.5grams Hb raised per one unit of blood

Ideal platelet count: 50,000+

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19
Q

**Below what amount of Hb do you always transfuse? What’s the goal in non-CV/hypotensive people? In CAD/angina/hypotensive patients?

A

less than 7gm. Goal is 8-9gm in non-CV/hypotensive. Keep at 9-10gm for CV-patients

20
Q

***List the clinical manifestations - signs and symptoms of appendicits

A
  1. Vague epigastric and periumbilical pain
  2. Discomfort shifts to RLQ associated
    N/V
  3. Pain worse: walking, coughing
  4. Low grade fever
21
Q

What type of atypical presentation of appendicitis is this?

Less abdominal pain, maybe right flank pain

A

Retrocecal appendix

22
Q

What type of atypical presentation of appendicitis is this?

Associated with pyuria or hematuria

A

Retroileal

23
Q

***Angiodysplasia often found in…

What type of bleeding does it cause?

A

cecum or ascending colon (RIGHT COLON)

Causes LGIB - most common cause of SI bleeds

24
Q

**What is the triad seen in elderly people that includes angiodysplasia?

A

Heyde Syndrome - angiodysplasia, Chronic Renal Failure, and Aortic Stenosis (systolic murmur radiating to carotid)

25
***What type of vessels if angiodysplasia found in?
submucosal vessels - flat vessels radiating from center Right Colon
26
**What is the cardinal appearance of angiodysplasia?
red stellate appearance
27
Patient takes ASA, NSAIDs and has GI bleed - what's the cause and UGIB and LGIB?
- UGIB - due to PUD causing erosive gastritis (alcohol or stress may also induce this) - LGIB - diverticulosis
28
Possibility of recurrent bleeding increases in PUD with what two situations?
1. ulcer greater than 2cm | 2. ulcer located on high on lesser curvature of stomach or in duodenum
29
**Painless, large volume blood loss via hematochezia/maroon stools most commonly due to what? What location?
DiverticuLOSIS in left colon
30
tx of diverticuLOSIS
endo-clipping
31
abdominal cramping and bloody diarrhea | What is the ischemic version of this associated with?
colitis (ischemic colitis, IBD, infection) | Ischemic associated with atherosclerosis
32
**Capsule endoscopy is good for what? If this doesn't find a bleed, what do you do next?
LGIB with unknown location - good for SI occult bleeding, 83% diangostic. If negative, do a tagged RBC scan.
33
When is surgery indicated in LGIB?
If interventional radiology/procedures failed or person requires 6+units of PRBC (blood) in 24hrs.
34
CT imaging of pelvic inlet shows thickened wall with ___ ___ = appendicits?
calcified appendicolith
35
Name the four signs likely seen with tenderness and guarding of RLQ.
This is acute appendicits 1. McBurneys - tenderness midway between right umbilicus and ASIS 2. Rovsing - rebound pressure on left side 3. Psoas - Person on left side, pain on passive hyeprextension of right hip 4. Obturator - pain on passive flexion and IR of R hip
36
When are CT-scans contraindicated?
In pregnant women with suspsected appendicitis, so use US
37
labs for appendicitis
leukocytosis (>11), postive CRP
38
High fever, diffuse abdominal tenderness, palpable mass, marked leukocytosis - suspect what?
perforated appendicitis
39
Tx of perforated appendicitis is?
emegent laparoscopic appendectomy
40
Pain is "all over abdomen", not localized. Decreased bowel sounds, distended, spasms taught BOARD-LIKE RIGIDITY, rebound tenderness. (also hypoT, tachycardia, sepsis, shock)
acute abdominal viscus perforation - Perforated Peptic-Gastric-Duodenal Ulcer
41
Free air under diaphragm indicates
acute abdominal viscus perforation - Perforated Peptic-Gastric-Duodenal Ulcer
42
Where do Perforated Peptic-Gastric-Duodenal Ulcer normally form?
When gastric contents spill into peritoneal cavity - usually from ulcer on ANTERIOR WALL of stomach or duodenum
43
Lab findings for acute abdominal viscus perforation
leukocytosis, left shift, increased amylase, increased CRP
44
Occult bleed in males
may cause iron deficiency anemia (IDA-men); always GIB or renal blood loss until proven otherwise
45
***treat varices with what?
octreotide
46
If pt need transfusion and has coagulopathy, consider what? | why begin PPI?
fresh frozen plasma and Vit K. PPI promotes platelet aggregation

GI 2 (9 decks)

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