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SURGERY > UGIB > Flashcards

UGIB Flashcards

1
Q

UGIB

A

Bleeding into the lumen of the proximal GI tract, proximal to the ligament of Treitz

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2
Q

UGIB signs and symptoms

A

Hematemesis, melena, syncope, shock, fatigue, coffee-ground emesis,
hematochezia, epigastric discomfort, epigastric tenderness, signs of hypovolemia, guaiac-positive stools

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3
Q

PUD

A

MC cause of significant UGIB

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4
Q

Bacteria associated w/ PUD

A

H. pylori

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5
Q

Treatment PUD

A

MOC - metronidazole, omeprazole, clarithromycin

ACO - ampicillin, clarithromycin, omeprazole

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6
Q

Valentino’s sign

A

RLQ pain/peritonitis as a result of succus collecting

from a perforated peptic ulcer

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7
Q

Duodenal Ulcers

A

pain relieves by food

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8
Q

Cause of DU

A

increased production of gastric acid

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9
Q

DU associated syndrome

A

Zollinger-Ellison syndrome

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10
Q

DU risk factors

A

Male gender, smoking, aspirin and other NSAIDs, uremia, Z-E syndrome, H. pylori, trauma, burn injury

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11
Q

DU symptoms

A 
Epigastric pain—burning or aching, usually several hours after a meal (food, milk, or antacids initially relieve pain)
Bleeding
Back pain
Nausea, vomiting, and anorexia
↓ appetite
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12
Q

DU signs

A 
tenderness in epigastric area (possibly)
guaiac-positive stool
melena
hematochezia
hematemesis
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13
Q

EGD findings associated w/ rebleeding

A

Visible vessel in the ulcer crater, recent clot, active oozing

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14
Q

DU medical treatment

A

PPIs (proton pump inhibitors) or H2 receptor antagonists—heal ulcers in
4 to 6 weeks in most cases

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15
Q

DU indications for surgery

A

Intractability
Hemorrhage (massive or relentless)
Obstruction (gastric outlet obstruction)
Perforation

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16
Q

Artery involved in bleeding duodenal ulcers

A

Gastroduodenal artery

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17
Q

Truncal vagotomy

A

Pyloroplasty

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18
Q

Duodenal perforation

A

Graham patch (poor candidates, shock, prolonged perforation)

Truncal vagotomy and pyloroplasty incorporating ulcer

Graham patch and highly selective vagotomy

Truncal vagotomy and antrectomy (higher mortality rate, but lowest recurrence rate)

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19
Q

DU intractability

A

PGV (highly selective
vagotomy)
vagotomy and pyloroplasty
Vagotomy and antrectomy BI or BII (especially if there is a coexistent pyloric/prepyloric ulcer) but associated with a higher mortality

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20
Q

Ulcer operation has the HIGHEST ulcer recurrence

rate and the LOWEST dumping syndrome rate

A

PGV (proximal gastric vagotomy)

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21
Q

Ulcer operation has

the LOWEST ulcer recurrence rate and the HIGHEST dumping syndrome rate

A

Vagotomy and antrectomy

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22
Q

Why must you perform a
(pyloroplasty, antrectomy)
after a truncal vagotomy?

A

Pylorus will not open after a truncal drainage procedure vagotomy

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23
Q

DU with lowest mortality rate

A

PGV (1/200 mortality), truncal vagotomy and pyloroplasty (1–2/200), vagotomy and antrectomy (1%–2% mortality)

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24
Q

Gastric Ulcers

A

40–70 years old (older than the duodenal ulcer population)

food increases GU pain

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25
Q

Cause of GU

A

DECREASED CRYOPROTECTION or gastric

protection (i.e., decreased bicarbonate/ mucous production)

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26
Q

GU associated increased gastric acid

A

prepyloric
pyloric
coexist w/ DU

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27
Q

GU risk factors

A

Smoking, alcohol, burns, trauma, CNS tumor/trauma, NSAIDs, steroids, shock,
severe illness, male gender, advanced age

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28
Q

GU symptoms

A

Epigastric pain

+/-Vomiting, anorexia, and nausea

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29
Q

GU diagnosis

A

History, PE, EGD with multiple biopsy (r/o gastric cancer)

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30
Q

GU MC location

A

lesser curvature - 70%

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31
Q

Options for concomitant duodenal and gastric ulcers

A

Resect (BI, BII) and TRUNCAL VAGOTOMY

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32
Q

Common option for surgical treatment of a PYLORIC gastric ulcer?

A

Truncal vagotomy and antrectomy (i.e., BI or BII)

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33
Q

Common option for a poor operative candidate

with a perforated gastric ulcer

A

Graham patch

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34
Q

Cushing ulcer

A

PUD/gastritis associated with NEUROLOGIC TRAUMA/TUMOR

35
Q

Curling’s ulcer

A

PUD/gastritis associated with MAJOR BURN INJURY

36
Q

Marginal ulcer

A

Ulcer at the margin of a GI anastomosis

37
Q

Dieulafoy’s ulcer

A

Pinpoint gastric mucosal defect bleeding from an underlying VASCULAR MALFORMATION

38
Q

Perforated Peptic Ulcer

A

Acute onset of upper abdominal pain

39
Q

Perforated Peptic Ulcer signs

A

Decreased bowel sounds
tympanic sound over the liver (air)
peritoneal signs
tender abdomen

40
Q

Signs of posterior duodenal erosion/ perforation

A

Bleeding from gastroduodenal artery (and possibly acute pancreatitis)

41
Q

Sign indicates anterior duodenal perforation

A

Free air (anterior perforation is more common than posterior)

42
Q

Perforated Peptic Ulcer associated lab findings

A

Leukocytosis

high amylase serum (secondary to absorption into the blood stream from the peritoneum)

43
Q

Perforated Peptic Ulcer initial treatment

A

NPO: NGT (↓ contamination of the peritoneal cavity)
IVF/Foley catheter
Antibiotics/PPIs
Surgery

44
Q

Piece of omentum incorporated into the suture closure of perforation

A

Graham patch

45
Q

Surgical options for treatment of a duodenal perforation?

A

Graham patch (open or laparoscopic)

Truncal vagotomy and pyloroplasty incorporating ulcer

Graham patch and highly selective vagotomy

46
Q

Surgical options

for perforated gastric ulcer?

A

Antrectomy incorporating perforated ulcer, Graham patch or wedge resection
in unstable/poor operative candidates

47
Q

Significance of
hemorrhage and perforation
with duodenal ulcer?

A

may indicate two ulcers (kissing); posterior is bleeding and anterior is perforated with free air

48
Q

Graham patch

A

For treatment of DUODENAL PERFORATION in poor operative candidates/unstable patients

Place viable omentum over perforation and tack into place with sutures

49
Q

Truncal vagotomy

A

Resection of a 1- to 2-cm segment of each vagal trunk as it enters the abdomen on the distal esophagus,
decreasing gastric acid secretion

50
Q

Other procedure must
be performed along with a
truncal vagotomy?

A

“Drainage procedure” (pyloroplasty, antrectomy, or gastrojejunostomy), because vagal fibers provide relaxation of the pylorus, and, if you cut them, the pylorus will not open

51
Q

Vagotomy and Pyloroplasty

A

Pyloroplasty performed with vagotomy to compensate for decreased gastric emptying

52
Q

Vagotomy and antrectomy

A

Remove antrum and pylorus in addition to vagotomy; reconstruct as a Billroth I or II

53
Q

Advantage of proximal gastric vagotomy (highly selective vagotomy)

A

No drainage procedure is needed; vagal fibers to the pylorus are preserved; rate of dumping syndrome is low

54
Q

Billroth I

A

Truncal vagotomy, antrectomy, and gastroduodenostomy

55
Q

Billroth I Contraindications

A

Gastric cancer or suspicion of gastric cancer

56
Q

Billroth II

A

Truncal vagotomy, antrectomy, and gastrojejunostomy

57
Q

Kocher Maneuver

A

Dissect the left lateral peritoneal attachments to the duodenum to allow visualization of posterior duodenum

58
Q

Stress gastritis

A

SUPERFICIAL mucosal erosions in the stressed patient

59
Q

Stress gastritis Risk factors

A

Sepsis, intubation, trauma, shock, burn, brain injury

60
Q

Stress gastritis prophylactic treatment

A

H2 blockers, PPIs, antacids, sucralfate

61
Q

Stress gastritis signs and symptoms

A

NGT blood (usually), painless (usually)

62
Q

Stress gastritis diagnosis

A

EGD - if bleeding is significant

63
Q

Stress gastritis treatment

A

LAVAGE out blood clots, give a maximum dose of PPI in a 24-hour IV drip

64
Q

Mallory Weiss Syndrome

A

Post-retching, postemesis longitudinal tear (submucosa and mucosa) of the stomach near the GE junction

~ 3/4 are in the stomach

d.t. Increased gastric pressure, often aggravated by hiatal hernia

65
Q

Mallory Weiss Syndrome Risk Factors

A

Retching, alcoholism (50%), 50% of patients have hiatal hernia

66
Q

Mallory Weiss Syndrome symptoms

A

epigastric pain
thoracic substernal pain
emesis
hematemesis

67
Q

Mallory Weiss Syndrome diagnosis

A

EGD

68
Q

Mallory Weiss Syndrome “classic” history

A

Alcoholic patient after binge drinking— first, vomit food and gastric contents,
followed by forceful retching and bloody vomitus

69
Q

Mallory Weiss Syndrome “classic” treatment

A

Room temperature water lavage (90% of patients stop bleeding)
electrocautery
arterial embolization
surgery for refractory bleeding

70
Q

Esophageal Variceal Bleeding

A

Bleeding from formation of esophageal varices from back up of portal pressure via the coronary vein to the submucosal esophageal venous plexuses secondary to portal hypertension from liver cirrhosis

2/3 of patients with portal
thirds” of esophageal hypertension develop esophageal varices

2/3 of patients with esophageal varices bleed

71
Q

Esophageal Variceal Bleeding signs and symptoms

A 
Liver disease
portal hypertension
hematemesis
caput medusa
ascites
72
Q

Esophageal Variceal Bleeding diagnosis

A

EGD

73
Q

Esophageal Variceal Bleeding medical treatment

A

Lower portal pressure with somatostatin and vasopressin

74
Q

Esophageal Variceal Bleeding surgical options

A

Sclerotherapy or band ligation via endoscope
TIPS
liver transplant

75
Q

Sengstaken- Blakemore balloon

A

Tamponades with an esophageal balloon and a gastric balloon

76
Q

Boerhaave’s syndrome

A

Postemetic esophageal rupture

posterolateral aspect of the esophagus (on location? the left), 3 to 5 cm above the GE junction - MC location

77
Q

Boerhaave’s syndrome cause of rupture

A

Increased intraluminal pressure, usually caused by violent retching and vomiting

78
Q

Boerhaave’s syndrome associated risk

A

Esophageal reflux disease (50%)

79
Q

Boerhaave’s syndrome symptoms

A

Pain postemesis (may radiate to the back, dysphagia)

80
Q

Boerhaave’s syndrome signs

A 
Left pneumothorax
Hamman’s sign
left pleural effusion
subcutaneous/mediastinal emphysema
fever
tachypnea
tachycardia
signs of infection by 24 hours
neck crepitus
widened mediastinum on CXR
81
Q

Mackler’s triad

A

emesis
lower chest pain
cervical emphysema (subQ air)

82
Q

Hamman’ sign

A

“Mediastinal crunch or clicking” produced by the heart beating against air-filled tissues

83
Q

Boerhaave’s syndrome treatment

A

Surgery within 24 hours to drain the mediastinum and surgically close the perforation and placement of pleural patch; broad spectrum antibiotics

84
Q

MC cause of esophageal perforation

A

Iatrogenic (most commonly cervical esophagus)

SURGERY (27 decks)

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