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ER 3 > UGI Bld > Flashcards

UGI Bld Flashcards

1
Q

UGI Bld Rx used to inhibit gastric acid?

A

Ocetreotide (somatostatin)

  • reduces BF to gastroduodenal mucosa
  • splenchnic V-con
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2
Q

Sentinal sign of severe illness is?

A

Lactate laboratory test

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3
Q

Vomiting and retching w/ hematemesis suggests?

A

M-W tear

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4
Q

What procedure is both DX and TXT for UGI Blds?

A

NG lavage

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5
Q

Other labs for UGI Bld?

A

Bun (elevated due to Hgb digestion/absorption)
Coags
CBC
Lactate (Elevated = sentinel sign of severe illness)

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6
Q

Mallory-Weiss is ass/w?

A

ETOH binge drinking, DKA, CHemo

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7
Q

Mallory-Weiss is classicly due to?

A

RPT vomiting w/ bright red hematemesis

Rarely - Valsalva like Cough/seizures

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8
Q

Profuse bleeding can cause ischemia where?

A

Cardiac or mesenteric

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9
Q

ESOPHAGEAL AND GASTRIC VARICES is due to?

A

portal hypertension (MC due to etoh liver disease)

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10
Q

UGI Bld pts w/ coagulopathy protocol?

A

Reverse coagulopathy w/out INR concern unless CI

<1.5 INR is req (M/M high otherwise)

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11
Q

erosive GASTRITIS AND ESOPHAGITIS is

A

Mucosal D/O due to stress causing, sepsis, or respiratory failure req ventilation

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12
Q

RX placing PT at high risk for bleeds?

A

Anticoags
Salicylates
CCS
NSAIDs

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13
Q

Most noxious portion of endoscopic procedure is when?

A

Passed around tongue

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14
Q

Is there evidence a NG tube will provoke bleeding w/ varices?

A

NO - ok to use

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15
Q

Hematemesis and coffee-ground emesis suggests?

A

UGI bld source

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16
Q

Short term TXT for life threatening Variceal?

A 
Balloon Tamponade (High rate of Comps)
Try intubating prior to.
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17
Q

RF for erosive GASTRITIS AND ESOPHAGITIS

A

alcohol, salicylates, and NSAIDs. Infection, toxic ingestion, radiation, and stress from severe illness

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18
Q

NG bloody aspirates may indicate?

A

High risk lesions

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19
Q

UGI Bld Surgery (Endoscopic/Rx failed) Variceal bleeding uncontrolled?

A

Shunt op- Trans-jugular intrahepatic portosys

Non-shunt op- Esophageal transection or GE jx Devascularization

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20
Q

MALLORY WEISS SYNDROME is

A

bld 2/2 longitudinal mucosal tear at gastroesophageal jx

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21
Q

UGI Bld ABX of choice? and indication?

A 
Liver cirrhosis (bacterial translocation concern)
Ciprofloxacin 400mg IV or Ceftriaxone 1g (IV)
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22
Q

S/S suggesting coagulopathy?

A

Petechiae/purpura

23
Q

UGI Bld SOC?

A

Endoscopy (w/in 24hr)

24
Q

Complications of balloon tamponade?

A

Ulcer
Rupture - esophagus/gastric
Asphyiation from tracheal compression
aspiration

25
Perform what type of PE?
ABD, HEENT, DRE, Heart, Lungs
26
Endoscopic protocol procedure if pt is CV unstable?
Etomidate or ketamine to sedate
27
PPI and PUD benefits?
Reduce need for surgery reduce Hospital stay duration S/S bleeding reduction
28
Endoscopic TXT of ulcers?
Clips Thermocoag Sclerosant INJ EPI INJ
29
PUD can be due to?
ASA, NSAID, Smoking or H. Pylori
30
MC cause of UGI bleed is?
PUD
31
PE S/S suggesting liver disease?
Spider angiomas Palmer Erythema, Jaundice Gynocomastia
32
UGI bld is diffrentiated from LGI bld how?
Ligament of Treitz
33
Endoscopic protocol procedure?
Sedate - Propfol Analgesic - Fentanyl N/V Ondansetron
34
Aortoenteric fistula presents?
Classic self-limited herald bleed w/ hematemesis or hematochezia preceding massive bleed.
35
Causes of UGI Bld
PUD Erosive Varices Mallory Weiss syndrome
36
UGI BLD vitals
``` HOTN Tachy-C/P Decreased pulse pressure Occ. Paradoxical brady-C w/ profound hypovolemia Shock ```
37
Most reliable way to DX UGI bld in ED?
Visual inspect vomit
38
Hematochezia simulators?
Red food/meds dyes/beets
39
UGI Bld most important Lab?
T/S and XM (CBC)
40
UGI Bld Surgery (Endoscopic/Rx failed) non-variceal bleeding uncontrolled?
Per-Q embolization or (Sub)-total gasteromy
41
Nonvariceal bleeding from PUD gets?
PPI (keep pH >6.0 (Omeprazole 80mg IV Bolus then 8mg Qhr)
42
UGI Bld dispo?
ICU - sig bleeding | Observe-D/C if very low risk pts
43
UGI Bld txt?
1st - Stabilize (Heme-shock req ER resus) | -2 Lrg bore IV's, T/S XM, massive transfusion, AW (hard to do)
44
UGI Bld Promotility agents like what? Used for?
Erythromycin and metoclopramide | enhances endoscopic visualization
45
What UGI BLD somatostatin Rx is ass/w reduced M/M?
Terlipressin
46
UGI BLD 1st line SOC is?
Endocopy (2nd Tagged RBC scitigraphy orvisceral angiography)
47
What study is CI in UGI Blds?
Barium contrast study (hinder endoscopy/angiography)
48
Other intresting causes of UGI bld?
AV Malform and Malig HEENT blds look like GI bld Aortoenteric fistula (2/2 aortic graft)
49
Endoscopic TXT of Variceal?
Variceal ligation or sclerotherapy
50
Recommended Bld Transfusion protocol
<7gm/dL most pts | <9gm/dL Older w/ comorbids no tolerating anemia
51
ETOH is ass/w?
peptic ulcer disease, erosive gastritis, esophageal varices
52
What can simulate melena?
Ingest Iron/Bismuth
53
Dx criteria for NG lavage?
W/out hematemesis Hx and a Positive aspirate = UGI Bld
54
Hematochezia or marron blood from rectum originates where MC?
UGI sources

ER 3 (6 decks)

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