Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Emergency Medicine Assistantship > GI Emergencies > Flashcards

GI Emergencies Flashcards

You may prefer our related Brainscape-certified flashcards:
Royal College: Emergency Medicine flashcards
1
Q

In which ways can an acute GI bleed present?

A

Haematemesis, coffee ground vomit, and melaena

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Which is more common - an upper GI bleed or a lower GI bleed?

A

Upper, by about 4 times.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the most important factor in prognosis following a GI bleed?

A

The size of the vessel affected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the most common cause of an acute upper GI bleed?

A

Peptic ulcers and oesophago-gastric varices.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Other than peptic ulcers and oesophageal varices, what are some causes of an upper GI bleed?

A
  • Gastritis
  • Duodenitis
  • Portal hypertensive gastropathy
  • Malignancy
  • Mallory-Weiss tear
  • Vascular malformation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

If peptic ulcer disease is suspected as the cause of an upper GI bleed, what factors in the history might support that diagnosis?

A
  • Alcohol abuse
  • Chronic renal failure
  • NSAIDs
  • Increasing age
  • Low socio-economic class
  • Hx of H. pylori
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How can the severity of a GI bleed be assessed initially?

A

By the extent of the blood loss and degree of shock.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What does haematemesis usually indicate?

A

Active haemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What does coffee-ground vomit usually indicate?

A

Bleeding has ceased, is modest, or lower upper GI.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What does melaena usually indicate?

A

Upper GI bleed, but also possible to be from small bowel or right side of colon.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is a Mallory-Weiss tear?

A

A tear of the lower oesophagus usually secondary to chronic excessive coughing or vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What signs of shock due to an acute bleed might be found on examination?

A 
Hypotension
Tachycardia
Pallor
Postural drop
Cool extremities
Chest pain
Confusion
Oliguria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

If an acute bleed has a chronic background, what additional signs might be elicited on examination?

A

Pallor and signs of anaemia
Evidence of dehydration
Stigmata of liver disease or signs of a tumour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the primary investiagtion with an acute GI bleed?

A

Endoscopy - oesophagogastroduodenoscopy for upper, and flexible sigmoscopy for lower GI bleed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How quickly should endoscopy be performed on a pt with an acute GI bleed?

A

Immediately after resus if severe and acute, but within 24 hours of admission for all other UGI bleeds.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which blood tests should be ordered on a pt with an acute gi bleed? Justify each answer.

A
  • FBC mainly for Hb
  • Cross match - 2-6 units
  • Coagulation profile and INR
  • LFTs (underlying liver disease)
  • U&Es (nitrogen:creatitine ratio, AKI)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What use would a CXR be in a pt with an acute upper GI bleed?

A

Can be used to exclude perforated viscus/ileus if performed upright.

Also can rule out aspiration and perforated oesophagus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the way to remember management for an acute GI bleed?

A

8Cs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the 8Cs of an acute GI bleed?

A
  • Crossmatch
  • Cannulate x2
  • Coagulation screen
  • Crystalloids
  • Catheter
  • Cold-prick drugs (warfarin etc)
  • Camera (OGD)
  • Call surgeons and for help!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the 2 scoring systems for acute upper GI bleeds?

A
  • Blatchford at first assessment

- Rockall score after endoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

A score of what on the Blatchford risk assessment indicates a pt needs intervention?

A

Anything more than zero.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

A score of what on the Rockall scale indicates a pt should be investiagted with endoscopy?

A

Anything more than zero.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What techniques are used to treat non-variceal bleeds once they are visualised on endoscopy?

A
  • Clips +/- adrenaline
  • Thermal coag + adrenaline
  • Fibrin/thrombin + adrenaline
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What techniques are used to treat variceal bleeds once they are visualised on endoscopy?

A
  • Terlipressin at presentation
  • Balloon tamponade
  • Band ligation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What benign anorectal pathology might cause a PR bleed?

A

Haemorrhoids
Anal fissure
Fistula-in-ano

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What benign colonic pathology might cause a PR bleed?

A

Diverticular disease

IBD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What malignant/premalignant pathology might cause a PR bleed?

A

Polyps

Colorectal or anal cancer

28
Q

How can a PR bleed present?

A

Anywhere on the spectrum between occult, moderate, and massive bleeding.

29
Q

What red flags with PR bleeding would make you suspect a malignant cause?

A 
Unexplained weight loss
Change in bowel habit
Tenesmus
FHx
PMHx
30
Q

How does retal bleeding tend to present wrt the amount of blood?

A

1 of 3 ways:

  1. Occult i.e. with anaemia
  2. Moderate e.g. small amounts visible in stool
  3. Massive bleeding with signs of shock
31
Q

Where is it likely to have come from if a PR bleed is:

  1. Bright fresh blood?
  2. Blood mixed with stool?
  3. Tar-like faeces?
A
  1. Lower down in GI tract
  2. Higher GI tract, middle ground
  3. Upper GI tract
32
Q

O/E of a pt with PR bleeding, what focussed points can be examined?

A
  • Pallor/anaemia
  • Signs of shock
  • Cachexia/weight loss
  • Abdominal masses
  • PR for any obvious pathology
33
Q

What baseline bloods are important for GI bleeds?

A
  • FBC
  • Iron studies
  • Clotting
  • LFTs
34
Q

Which additional test can be performed in a young pt with a GI bleed, and why?

A

Faecal calprotectin as it is a useful screen for IBD.

35
Q

What are the 2 categories of abdominal trauma?

A

Blunt and penetrating

36
Q

Which organs are most commonly dama n blunt abdominal trauma?

A

Liver and spleen

37
Q

What mechanisms are common for blunt abdominal trauma?

A

Blow from an external object e.g. seatbelt

Deceleration forces

I.e. very common in RTCs

38
Q

What might cause trauma penetrating the abdomen?

A

Gunshot, shrapnel, stab wound, RTC… loads of ways

39
Q

Which observation measured out of hospital is a sign of more significant intra-abdominal injuries?

A

Hypotension

40
Q

If a patient has had blunt trauma to the abdomen, but has no signs on examination, can we send them home?

A

No - they need serial examinations and imaging to exclude occult injuries.

41
Q

What is the seat-belt sign?

A

Bruising across site of lap portion of seatbelt that has high levels of association with abdominal organ damage.

42
Q

Which organ is most at risk in children who have the seatbelt sign?

A

Pancreas

43
Q

Following abdomina trauma, what might abdominal breathing pattern indicate?

A

Spinal cord injury

44
Q

What is Cullen’s sign?

A

Periumbilical eccymosis indicating retroperitoneal haemorrhage

45
Q

A patient who has been in an RTC has abdominal trauma. They have signs of peritonitis. What is the cause likely to be if this is noted:

  1. immediately?
  2. 5 hours after the incident?
A
  1. Leakage of intestinal contents

2. Intra-abdominal haemorrhage

46
Q

What bedside tests are important in abdominal trauma?

A
  • Glucose levels
  • Urinalysis
  • Pregnancy test
47
Q

Which imaging investiagtion is used in haemodynamically unstable trauma patients?

A

FAST - Focused abdominal sonography for trauma

48
Q

Which imaging investiagtion is used in haemodynamically stable trauma patients?

A

CT abdomen

49
Q

Why is acute pancreatitis so painful?

A

Inflammation of pancreas causes exocrine enzyme release which autodigests the pancreas.

50
Q

What are the top 2 causes of acute pancreatitis?

A

Gallbladder disease

Excess alcohol consumption

51
Q

How do gallstones cause pancreatitis?

A

Blockage of the bile duct, which creates back-pressure into the pancreatic duct

52
Q

What is the acronym for the causes of pancreatitis?

A

GET SMASHED

53
Q

What are the causes of pancreatitis according to the GET SMASHED acronym?

A 
Gall stones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion poison
Hypercalcaemia/Hypercholesterolaemia/Hypothermia
ERCP
Drugs
54
Q

Which drugs can cause acute pancreatitis?

A

Thiazides
Sodium valproate
Azathioprine

55
Q

A man comes to A&E with sudden onset severe abdominal pain an vomiting, which radiates to his back. What blood test should we 100% do?

A

Amylase!

56
Q

A man comes to A&E with sudden onset severe abdominal pain an vomiting, which radiates to his back. How should this patient be assessed initially?

A

ABCDE assessment

57
Q

A man comes to A&E with sudden onset severe abdominal pain an vomiting, which radiates to his back. What sign can we look for on examination that might suggest origin in the bile duct?

A

Presence of jaundice

58
Q

What are the worrying signs on examination of a patient with ?pancreatitis?

A
  • Gross hypotension
  • Pyrexia
  • Tachypnoea
  • Ascites
  • Pleural effusion
  • Cullen’s sign or Grey Turner’s sign
59
Q

What amylase suggests acute pancreatitis?

A

Rasied 3 times upper limit of normal

60
Q

A man comes to A&E with sudden onset severe abdominal pain an vomiting, which radiates to his back. What are your top differentials that need ruling out?

A

Pancreatitis
Small bowel perforation/obstruction
Ruptured or dissecting AA
Atypical MI

61
Q

How is the severity of pancreatitis measured?

A

Using the Glasgow score

62
Q

How does the Glasgow score measure prognosis in pancreatitis?

A

Point for:

  • Age over 55
  • WCC over 15
  • Urea over 16
  • Glucose over 10
  • pO2 under 8
  • Albumin under 32
  • Calcium under 2
  • LDH over 600
  • AST/ALT over 200

3 or more indicates severe pancreatitis

63
Q

How should mild pancreatitis cases be managed?

A 
Supportively:
-Analgesia
-IV fluids if NBM
Abx if specific infection present
NG tube if severe vomiting
Treat the cause e.g. bile duct clearance if gallstones cause.
64
Q

How should severe pancreatitis cases be managed?

A
  • ITU/HDU admission
  • IV abx for pancreatic necrosis
  • Enteral nutrition (NG tube inserted into the jejunum)
  • Surgery for infection and necrosis
65
Q

What are the complications of acute pancreatitis?

A
  • Pancreatic necrosis
  • Infected necrosis
  • Acute fluid collections
  • Pancreatic abscess
  • Acute cholecystitis
  • Systemic complications

Emergency Medicine Assistantship (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions