Upper GI Bleeds - Thackeray

Question 1

What should be your initial assessment and resuscitation for someone with a GI bleed?

Answer 1

Remember ABC’s

• Airway?
• CPR?

IV access
-At least 2 large bore IVs (need volume)

Infusion

• Crystalloid (saline stuff)
• Blood products

Question 2

How do esophageal varices present? What is the underlying cause?

Answer 2

Presentation: Dramatic bleeding, usually hematemesis
Causes: Portal hypertension
Associated with: Liver disease/cirrhosis

Treatment: (not important for test)
Octreotide or Vasopressin
Proton Pump inhibitor
Non-selective Beta-blocker
Variceal band ligation
TIPS/Surgical shunt

Question 3

Difference in definition between erosions, ulcers, and peptic ulcer disease?

Answer 3

Ulcer
-Break in mucosa with appreciable depth at endoscopy or with involvement of the submucosa
Erosion
-Break in mucosa without significant depth
Peptic Ulcer Disease
-Ulcer or Erosion in the stomach or duodenum from a number of causes

Question 4

Risk factors for Peptic Ulcer Disease?

KNOW THIS!

Answer 4

H. Pylori (Odds Ratio 4.05)***

Non-steroidal anti-inflammatory drugs (NSAIDs) (OR 2.99)***

H.Pylori + NSAID = synergistic effect (OR 15.4)

Question 5

Serology for H. Pylori can be done for the original diagnosis, but what tests would you use to confirm that H. Pylori is gone after treatment?

Answer 5

Breath test
or
stool test