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GI/Hepatic > SUP GIB > Flashcards

SUP GIB Flashcards

1
Q

Stress ulcers

A

Form of hemorrhagic gastritis that may occur in patients who have had a major stressful event

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2
Q

NSAID ulcers vs stress ulcers

A

Stress ulcers cause more congestion and bleeding than NSAID-induced ulcers
Will eventually involve multiple sites in the GI tract

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3
Q

Hypothesized pathogenesis

A

Acid hypersecretion
Reduction in GI mucosal blood flow during acute injury and impaired perfusion of the gut
Reduction in normal protective mechanisms during acute injury

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4
Q

Risk factors (only need 1) for SUP

A 
Mechanical ventilation
Coagulopathy (PLT < 50,000, INR > 1.5)
Thermal injury 
Severe head or spinal cord injury
GI bleeding or ulceration within past year
Multiple trauma
Perioperative transplant period
Low intragastric pF
Surgery > 4 hours
Acute lung injury
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5
Q

Risk factors (2+) for SUP

A 
Sepsis syndrome
ICE stay > 1 wk
Occult bleeding
High dose corticosteroids
Hepatic failure
Acute renal insufficiency Hypotension
Anticoagulation
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6
Q

Pharmacologic SUP

A

Sucralfate
Antacids
H2RAs
PPIs

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7
Q

Sucralfate MOA

A

Works by coating and protecting the gastric mucosa

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8
Q

Which medications for SUP require a functioning GI tract?

A

Sucralfate

Antacids

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9
Q

Sucralfate frequency

A

Must be dosed frequently

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10
Q

What toxicity is possible with sucralfate?

A

Aluminum

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11
Q

Which SUP can cause tolerance?

A

H2RAs

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12
Q

What ADR is rare in H2RAs

A

Thrombocytopenia

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13
Q

Other agents for SUP?

A

Misoprostol
Enteral feedings
Allopurinol
Dimethyl sulfoxide

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14
Q

GIB locations

A

Can occur in multiple sites

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15
Q

Definitions of GIBs

A

Upper (5x more common)
Lower
Occult (unknown to pt)
Obscure (from an unknown site in the GI tract)

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16
Q

Increased risk for patients with GIBs

A

> 60 years of age
In shock
With poor overall health status
Co-morbid illnesses

17
Q

Types of GIBs

A

Variceal

Non-variceal

18
Q

Causes of non-variceal GIB

A

Peptic ulcer
Mallory-Weiss tears
Less/frequent rare causes: tumors, Crohn’s disease, arteriovenous malformation

19
Q

Peptic ulcers caused by

A 
Primarily caused by H pylori
Stress ulcers
ASA
NSAID
Radiation
Chemo
Zollinger-Ellison syndrome
Vascular insufficiency
20
Q

Mallory-Weiss tear

A

Tear in the mucosal layer at the junction of the esophagus and stomach

21
Q

GIB s/sx

A 
Hematemesis
Melena
Hematochezia
Anemia
Tachycardia
Orthostasis
Hypotension
Fatigue
Weakness
Ab pain
Pallor
Dyspnea
22
Q

The use of what medications would we look for in a pt hx?

A 
Anti-platelet agents
NSAIDs
Warfarin
Directa cting oral anticoagulants
Heparin
LMWH
Thrombolytic agents
GPIIb/IIIa receptor antagonists
Direct thrombin inhibitors
23
Q

How does GIB affect bowels?

A

May be hyperactive in acute GIB - Bowel sounds will be affected

24
Q

Labs in GIB

A 
CBC
Coagulation parameters
Fecal occult blood test
LFTs
BUN
25
Q

Diagnostic tests for GIB

A

Endoscopic exams (pre-endoscopic IV PPI is recommended)

  • Sclerotherapy
  • Thermal coaptive therapy
26
Q

Basic treatments of GIB

A

If intravascular volume is low, it should be replaced
Acid suppression
If coagulopathy is present, this must be corrected. Any of the following may need to be done

27
Q

When is risk of re-bleeding greatest in GIB?

A

w/in 72 hours of initial presentation

28
Q

What intragastric pH is necessary to prevent clot dissolution?

A

> 6

29
Q

Guidelines recommend which drugs to increase pH in GIB?

A

PPI

30
Q

Which PPIs are in IV form?

A

Nexium

Protonix

31
Q

When is it okay for oral PPIs after endoscopy in GIB?

A

If endoscopy only deteched flat-spot or clean-based ulcer (no clot)

32
Q

Pharmacotherpay follow-up considerations (after endoscopy of GIB)

A

Test for H pylori (repeat if negative) and treat H pylori infection if present. No need for PPI after eradication
If non-H pylori bleed, continue oral PPI therapy for 6-8 weeks
Stop NSAIDs if possible - if not possible it is recommended to use a cox-2 inhibitor in combination with an oral PPI
If low-dose ASA is required, reinitiate when CV risks outweight GI risks (add a PPI)
Assess for ability to stop anticoagulants. If patients must remain on them, arrange for close follow up and add a PPI

GI/Hepatic (7 decks)

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