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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
Q

Perform what type of PE?

A

ABD, HEENT, DRE, Heart, Lungs

26
Q

Endoscopic protocol procedure if pt is CV unstable?

A

Etomidate or ketamine to sedate

27
Q

PPI and PUD benefits?

A

Reduce need for surgery
reduce Hospital stay duration
S/S bleeding reduction

28
Q

Endoscopic TXT of ulcers?

A

Clips
Thermocoag
Sclerosant INJ
EPI INJ

29
Q

PUD can be due to?

A

ASA, NSAID, Smoking or H. Pylori

30
Q

MC cause of UGI bleed is?

31
Q

PE S/S suggesting liver disease?

A

Spider angiomas
Palmer Erythema,
Jaundice
Gynocomastia

32
Q

UGI bld is diffrentiated from LGI bld how?

A

Ligament of Treitz

33
Q

Endoscopic protocol procedure?

A

Sedate - Propfol
Analgesic - Fentanyl
N/V Ondansetron

34
Q

Aortoenteric fistula presents?

A

Classic self-limited herald bleed w/ hematemesis or hematochezia preceding massive bleed.

35
Q

Causes of UGI Bld

A

PUD
Erosive
Varices
Mallory Weiss syndrome

36
Q

UGI BLD vitals

A 
HOTN
Tachy-C/P
Decreased pulse pressure
Occ. Paradoxical brady-C w/ profound hypovolemia
Shock
37
Q

Most reliable way to DX UGI bld in ED?

A

Visual inspect vomit

38
Q

Hematochezia simulators?

A

Red food/meds dyes/beets

39
Q

UGI Bld most important Lab?

A

T/S and XM (CBC)

40
Q

UGI Bld Surgery (Endoscopic/Rx failed) non-variceal bleeding uncontrolled?

A

Per-Q embolization or (Sub)-total gasteromy

41
Q

Nonvariceal bleeding from PUD gets?

A

PPI (keep pH >6.0 (Omeprazole 80mg IV Bolus then 8mg Qhr)

42
Q

UGI Bld dispo?

A

ICU - sig bleeding

Observe-D/C if very low risk pts

43
Q

UGI Bld txt?

A

1st - Stabilize (Heme-shock req ER resus)

-2 Lrg bore IV’s, T/S XM, massive transfusion, AW (hard to do)

44
Q

UGI Bld Promotility agents like what? Used for?

A

Erythromycin and metoclopramide

enhances endoscopic visualization

45
Q

What UGI BLD somatostatin Rx is ass/w reduced M/M?

A

Terlipressin

46
Q

UGI BLD 1st line SOC is?

A

Endocopy (2nd Tagged RBC scitigraphy orvisceral angiography)

47
Q

What study is CI in UGI Blds?

A

Barium contrast study (hinder endoscopy/angiography)

48
Q

Other intresting causes of UGI bld?

A

AV Malform and Malig
HEENT blds look like GI bld
Aortoenteric fistula (2/2 aortic graft)

49
Q

Endoscopic TXT of Variceal?

A

Variceal ligation or sclerotherapy

50
Q

Recommended Bld Transfusion protocol

A

<7gm/dL most pts

<9gm/dL Older w/ comorbids no tolerating anemia

51
Q

ETOH is ass/w?

A

peptic ulcer disease,
erosive gastritis,
esophageal varices

52
Q

What can simulate melena?

A

Ingest Iron/Bismuth

53
Q

Dx criteria for NG lavage?

A

W/out hematemesis Hx and a Positive aspirate = UGI Bld

54
Q

Hematochezia or marron blood from rectum originates where MC?

A

UGI sources

ER 3 (6 decks)

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