GI SS 3

Question 1

Acute LGIB with Rectal pain

Answer 1

External Hemorrhoids

Anal fissure

Question 2

Occult GI bleed FOBT

Answer 2

POS FOBT without anemia equals colonoscopy

POS FOBT with anemia equals upper endoscopy and colonoscopy

Question 3

Ligament of Treitz (2)

Answer 3

Muscle Suspends duodenum (Allows movement of intestinal contents) Anatomical Landmark Dividing Proximal the UGIB and Distal the LGIB

Question 4

Black

Answer 4

Upper GI

Question 5

Melena (quan)

Answer 5

dark tarry stool (As little as 50ml)

Question 6

Acute Upper GI Bleeding Etiologies

Answer 6

Peptic Ulcer Disease (PUD)
Portal Hypertension  Esophageal Varices (high mortality)
MalloryWeiss Tear
Vascular Anomalies
Gastric Neoplasm
Erosive Gastritis  associated with NSAID or Alcohol
Erosive Esophagitis  chronic GERD
Booerhave Syndrome

Question 7

Acute LGIB Dx tests

Answer 7

1st Distinguish UP vs LOW GI Bleed

Question 8

Acute Upper GI Bleeding presentation

Answer 8

Hematemesis
Melena
Rarely hematochezia (Req greater than 1L for UGIB)
Maybe associated with pain (Epigastric abdominal)

Question 9

Acute LGIB with no pain

Answer 9

Internal hemorrhoids

Diverticular bleeding

Question 10

Therapeutic colonoscopy

Answer 10

Vasoconstrictive injection cautery clipsorbands

Question 11

Obscure GI Bleeding (3)

Answer 11

Unknown origin Upperorlower endoscopic eval equals MC from SML int

Question 12

Acute LGIB with Abd painorcramps

Answer 12

IBD

Colitis

Question 13

Hematochezia

Answer 13

Fresh blood passed into stool

Question 14

Acute LGIB 2 Points

Answer 14

Majority bleeds from colon Lower risk of serious blood loss than UGIB

Question 15

EGD

Answer 15

All patients with active Upper GI bleed

Question 16

Occult GI bleed Lab tests (3)

Answer 16

Fecal Occult Blood Test
Fecal Immunochemical Test Only detects LGIB
CBC unexplained anemia

Question 17

High risk Patients for Acute UGIB (Admit where?)

Answer 17

Age greater than 60
Comorbid illnesses
SBP less than 100 mmHg
Pulse greater than 100 bpm
Bright red blood in NG aspirate or upon rectal examination
Admit to ICU

Question 18

Acute Upper GI Bleeding DX features

Answer 18

Hematemesis
Varying degrees of hypovolemia
Pos or Neg Melena (may be hematochezia in massive bleed)

Question 19

Unstable Acute UGIB

Answer 19

IV
CBC PTorINR CMP type and screen
Fluid (isotonic fluids) or Blood Replacement (24 pRBC)
NG Tube Aspiration of blood or coffee ground material

Question 20

Acute LGIB with Large volume

Answer 20

Diverticular bleeding

Question 21

Assessment and stabilization of hemodynamic status UGIB

Answer 21

Stable vs Unstable Unstable SBP less than 100 (severe)

Question 22

Hematemesis

Answer 22

Vomiting blood

May be bright red or ‘coffeeground’ material

Question 23

Occult GI bleed (2)

Answer 23

No SandS May lose up to 100mlorday

Question 24

Surgery Acute LGIB

Answer 24

Last resort

Indicated if requires greater than 6 units of PRBC in 24 hrs or more than 10 units total

Question 25

Acute LGIB with Small volume

Answer 25

IBD has bloody diarrhea | Hemorrhoids has small drips into the toilet; blood when wiping; bloody streaks on stool

Question 26

Anorectal Diseases

Answer 26

Hemorrhoids fissures ulcers

Question 27

Acute UGIB Meds

Answer 27

IV or PO PPI IVOctreotide

Question 28

Acute LGIB Etiologies (less than50yo) ML's

Answer 28

Anorectal Diseases Inflammatory Bowel Disease Infectious Colitis

Question 29

Octreotide

Answer 29

Decreases portal blood pressure (lowers rebleed risk)

Question 30

Acute LGIB Labs

Answer 30

CBC CMP | Anemia equals ominous sign for suspected neoplasm

Question 31

Maroon

Answer 31

Small intestine or right colonic source or

Question 32

Inflammatory Bowel Disease (2 types)

Answer 32

Ulcerative Colitis Crohn Disease

Question 33

Gastrointestinal Bleeding Types

Answer 33

Upper GI Bleeding Lower GI Bleeding Obscure GI Bleeding Occult Bleeding

Question 34

Acute LGIB Etiologies (greater than50yo) ML's

Answer 34

Diverticulosis Lrg Volume painless bright red Neoplasm Angioectasias (greater than 70 yrs) Ischemic Colitis

Question 35

Bright red blood color equals

Answer 35

Left colonic source | Hemorrhoids fissure diverticulitis IBD colitis

Question 36

Acute LGIB Treatments for LRG volume bleeding

Answer 36

Therapeutic colonoscopy Intraarterial embolization Surgery

Question 37

Acute LGIB Dx features

Answer 37

Hematochezia With or Without pain