GI mc 1 Flashcards
what does tahycard and hypovol suggest with GI bleed
2L blood loss
what is stage 3 shock
2L blood loss
why is RR elevated in GI blood loss
increase oxygen delivery to the circulation and prevent tissue hypoxia
good measurement for severity of GI blood loss ilness
RR
what happens to CRT in GI blood loss
longer
immediate treatment for stage 3 blood loss
500 mL IV crystalloid containing 130-154 mmol/L Na over 15 minutes or less is indicated
what blatchford score = endoscopy urgent
above 6
what dosent blatchford include
endoscopy
what follows IV fluid in GI blood loss
transfusion of two units of cross-matched packed red cells
what significantly reduces rate of rebleeding in peptic ulcers
PPI
advantages of PPI
decrease the length of hospital stay, rebleeding rate, and need for blood transfusion in patients with high-risk ulcers treated with endoscopic therapy
how do PPIs work
inhibiting the parietal cell H+/K+ ATP pump
what to withold in GI bleed
amlodipine and ramipril
- hypotensives
four major risk factors for bleeding peptic ulcers are
Helicobacter pylori infection
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Physiologic stress
Excess gastric acid
what is it when yperacidity causes the ulcer
ZES
essential in UGIB
control of acid
what is mucosal damage by NSAIDs and aspirin method
inhibition of COX-1
what does inhibition of COX-1 do
reduces mucosal generation of protective prostaglandins (PG) such as PGE2
what increases risk of complications with GUD
duration and dose of NSAIDs
age
PMH
glucocorticoids, anticoagulants, clopidogrel, bisphosphonates SSRIs
prostaglandin E analog
misoprostol
what bad thing is COX-2 associated with
risk of cardiovascular disease
how to test for h pylori
CLO
faecal test
urea breath tests
what is the CLO test
biopsy on agar containing urea and pH → alkaline pH and colour change if present
what to avoid with metronidazole
alcohol - as risk of disulfiram interaction
what to avoid with calrithromycin
simvastatin = myositis
severe UC management
oral glucocorticoids and combination therapy with high dose oral 5-ASA, suppository- 5ASA or steroid, steroid enema or foam
if a patient with UC is improving what do you give instead of IV hydrocortisone
oral prednisolone
Fulminant colitis treatment
IV glucocorticoids + broad spectrum antibiotics
Azathioprine is converted to
6-mercaptopurine
how is azathioprine converted
nonenzymatic nucleophilic attack by sulfhydryl-containing compounds
what to do before giving azathioprine
TPMT test needed to make sure its active
Infliximab
Monoclonal antibody binding to tumor necrosis factor alpha
when do you get high TNF alpha
rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, plaque psoriasis, Crohn’s disease and UC
what does TNF alpha do x6
induces proinflammatory cytokines enhancement of leukocyte migration activation of neutrophils and eosinophils leukocyte migration neutrophil/ eosinophil activation apoptosis of T cells
how to end steroids
gradually so you dont get addisons
