stomach, duodenum, GI bleeds

Question 1

hematochezia

Answer 1

bright red blood, typically from lower GI bleed

Question 2

acute labs ordered for GI bleeding may not have an accurate….

Answer 2

Hct

Question 3

50% of all upper GI bleeds are from?

Answer 3

peptic ulcer disease, majority of which are from H. Pylori or NSAIDs

Question 4

PUD tx

Answer 4

intravascular fluid resuscitation, IV PPI, urgent/emergent endoscopy

Question 5

which type of hemorrhoid is painful?

Answer 5

prolapsed internal, needs to be fixed within 24-48 hours

Question 6

where is meckel’s diverticulum usually located?

Answer 6

within 100 cm of ileocecal valve

Question 7

what med to use for prevention of variceal re-bleed?

Answer 7

propranolol

Question 8

( ) inhibit prostaglandin, bicarbonate, and mucus production

Answer 8

NSAIDs

Question 9

best test for H. Pylori is….

other options include….

Answer 9

upper endoscopy w/biopsy

breath test, stool sample

Question 10

triple therapy for H. Pylori

Answer 10

PPI (continue 8 weeks after tx)
Clarithromycin or Metronidazole
Amoxicillin or Metronidazole if not used

Question 11

whats meds need to be d/c before an H. Pylori stool/breath test?

Answer 11

PPI
Bismuth subsalicylate
antibiotics

Question 12

Alcoholic, intense episode of emesis, now with UGI bleeding.

Answer 12

mallory weiss syndrome

Question 13

gastroparesis

Answer 13

• stomach takes longer to empty
• common with diabetics
• Pts says they used to eat a lot and then they get early satiety

Question 14

how to dx gastroparesis

Answer 14

gastric emptying scan

Question 15

signs of gastric adenomacarcinoma

Answer 15

• palpable enlarged stomach
• enlarged virchows lymph nodes
• hepatomegaly

Question 16

primary cause of gastric cancer

Answer 16

H. Pylori

Question 17

how does PUD present?

Answer 17

• epigastric pain, may bore into back

- bleeding

Question 18

how do duodenal ulcers present?

Answer 18

• these can bleed

- relief gained from OTC meds and eating

Question 19

Zollinger-Ellison Syndrome

Answer 19

-endocrine tumor disorder, direct result of gastrinoma
Suspect in patients with multiple peptic ulcers, recurrent ulcer disease, duodenal or jejunal ulcers, family history of MEN1
Diarrhea or steatorrhea

Question 20

how to dx Zollinger-Ellison

Answer 20

Fasting serum gastrin concentration >1000 pg/ml (normal is <110)
Pts on PPIs will have high levels of gastrin, so they have to come off this to test