GI Emergencies - McGowan Flashcards
Hematemesis associated with alcohol use and persistent vomiting, in an otherwise healthy person is most likely _
Mallory Weiss tear
GI Ulcer associated with elevated intracranial pressure
Cushing’s ulcer
GI ulcer associated with severe burn
Curling ulcer
what is red wale marking
endoscopic sign suggestive of recent hemorrhage, or propensity to bleed, seen in people with esophageal varices
best initial treatment of active bleed to lower risk of rebleeding of the esophagus
Variceal banding
what is fetor hepaticus
aka breath of the dead or hepatic foetor, seen in portal HTN where portosystemic shunting allows thiols to pass directly into lungs
Upper GI bleed is proximal to
ligament of Treitz
Common causes of upper GI bleed
- peptic ulcer disease (MOST COMMON)
- Portal HTN
- mallory-Weiss Tears
- Angiodysplasias
- Telangiectasias
- Dieulfoy lesion
- Neoplasms
- Erosive gastritis
- Aortoenteric fistula
Systemic blood pressure lower than _ is at high risk of acute bleed
100
T or F: pt with acute bleed needs to have one 18 gauge or larger IV lines
False. Needs to have two*
Pt with BUN:Cr 30:1 with no renal issues, think what
Upper GIB - absorption of blood nitrogen from small intestine and prerenal azotemia
If a patient shows hemodynamic compromise or overt active bleed, what is the first thing you should try to fix?
Replenish fluid with 0.9 % (Normal) saline or LR
- type and cross match 2-4 units of PRBCs
Pt with active bleed, packed RBC should be given to maintain hbg at what level?
7-9
when is blood transfusion indicated in a GIB pt?
when is platelet transfuction indicated? plasma?
Transfuse blood in an actively bleeding pt whose hgb is below 7.
Transfuse platelet if count is <50,000
Transfuse fresh frozen plasma if pt has coagulopathy with INR > 1.8
EGD are usually safe with INR less than
2.5
what are clinical predictors of increased risk of rebleeding and death?
- age over 60
- comorbid illnesses
- SBP <100
- HR >100
- bright red blood in NG aspirate or on rectal exam
Virtually all patients with UGIB should undergo _ within 24 hrs of arriving to ED
endoscopy
Portal HTN pts with UGIB should be given what meds?
PPI plus IV octreotide which reduces splanchnic blood flow and decreases portal blood pressure
when is transvenous intrahepatic portosystemic shunts (TIPS) indicated?
in liver patient that fails endoscopic modalities
when is surgery for peptic ulcer disease indicated?
- uncontrolled bleeding
- performation
- obstruction
- intractable disease
- suspected malignancy
How is esophageal variceal bleed treated?
- Hemodynamic resuscitation
- FFP for coagulopathy, platelet if indicated
- ABX prophylaxix (3rd gen cephalosporin)
- Somatostatin and octreotide
- Endoscopic therapy (banding)
- Vit K for cirrhotic pts
- Lactulose for encephlopathy
- Balloon tube tamponade used if cannot be controlled by meds or endoscopic techniques
How is esophageal variceal rebleed prevented?
- BB (nadolol, propranolol) plus banding
- TIPS
- Liver transplant
what are some etiologies of lower GI bleed?
- < 50: infectious colitis, anorectal disease, IBD
- > 50: diverticulosis, angioectasias, malignancy, or ischemia
- Diverticulosis: most common cause of major LGIB (acute, painles, large volume, maroon or bright red hematochezia
- Angioectasias (common in pts >70 with CKD
- neoplasms
- IBD
- anorectal disease
- Ischemic colitis: crampy abd pain followed by rectal bleeding and no more abd pain, self limited
most common cause of intestinal obstruction
peritoneal adhesions. can occur at anytime after a laparotomy. intra-abd infection, ischemia, and peritonitis are at increased risk
