Summary of Essentials - Ch. 48- (GI) Flashcards
Most common cause of melena?
UGI bleed
Presentation - bloody emesis in a patient who is critically ill and in the ICU?
Stress ulceration
Presentation - bloody emesis in a patient with a history of aortic surgery?
Aortoenteric fistula
Work-up for suspected aortoenteric fistula?
Endoscopy and CT (gas/stranding around graft)
Dx cause of bloody emesis?
If unclear whether upper or lower GI - NG tube lavage
Management of UGI bleed?
- ABCs, 2 large-bore IVs, type and cross
- If massive bleed, consider intubation
- Transfuse Hgb below 7
- Start PPI early
- Triple therapy for H. pylori eradication
- Admit to montored setting
- Upper endoscopy with 12 hours (most can be Rx with endoscopic techniques)
- Calculate MELD?
When is surgery indicated in the setting of an UGI bleed?
Duodenal ulcer (open duodenum, 3-point ligation of ulcer), gastric ulcer (excise and close for acute vs. distal gastrectomy for chronic)
Which type of varices are more difficult to treat and do not respond well to banding or sclerotherapy?
Gastric (vs. esophageal)
In the setting of isolated gastric varices along the greater curve, consider ___ from prior pancreatitis. ___ is curative.
Splenic vein thrombosis; splenectomy
What can be used to prevent recurrent bleeding from esophageal varices?
Propranolol
Presentation - sudden onset severe epigastric pain that becomes diffuse, history of PUD/H. pylori/smoking/chronic NSAIDs, evidence of SIRS, lying motionless in bed, peritoneal signs
Perforated peptic ulcer
What are the 5 types of gastric ulcers?
I - lesser curve of stomach II - in stomach and duodenum III - pre-pyloric IV- proximal by the cardia V - 2/2 NSAID use
Work-up of suspected perforated peptic ulcer?
Upright CXR - free air under diaphragm
CT with oral gastrografin
Management of perforated duodenal ulcer?
Primary closure with omental patch
Management of perforated gastric ulcer?
Primary closure, biopsy, omental patch vs. wedge resection (must rule out malignancy)
Rx H. pylori?
Triple therapy - clarithromycin, amoxicillin, PPI for 14 days
Most common type of stomach cancer?
Adenocarcinoma (2 types - intestinal and diffuse)
Most common cause of stomach cancer?
H. pylori infection
This type of gastric cancer is poorly differentiated, occurs most often in the proximal stomach, and is often related to congenital disorders
Diffuse type
This type of gastric cancer occurs in the distal stomach and is associated with environmental factors
Intestinal-type
What is infiltration oft he entire gastric wall with cancer?
Linitis plastica
What are GIST tumors?
Smooth, submucosal tumors that express c-KIT and CD117
Study of choice to dx gastric cancer?
Endoscopy
Further staging with CT chest, A/P, and/or PET
Management of gastric cancer?
Stage IB or higher - pre-operative chemo
Surgery: tumor distal to stomach - subtotal gastrectomy vs. in proximal stomach: proximal gastrectomy or total gastrectomy
Post-operative chemo and radiation