Upper GIB Flashcards
What classifies a bleed as an Upper GIB?
Source is proximal to the ligament of Treitz
What is the most common cause of an Upper GIB?
PUD
Hematemesis
Vomit is bright red
“coffee ground” emesis
Melena
Dark stool, develops with small amounts of blood
Hematochezia
Bright red stool, MASSIVE GIB
How will a Massive GIB present?
Hematochezia
4ish co-morbid conditions that occur with Upper GIB?
Aortic Stenosis and renal disease
Smoking and liver disease
Alcohol abuse
H. Pylori and NSAIDs
4ish co-morbid conditions that occur with Upper GIB?
Aortic stenosis and renal disease
Smoking and liver disease
Alcohol abuse
H. Pylori and NSAIDs
Physical exam findings with an Upper GIB?
Tachycardia
Orthostatic/Supine Hypotension
ACUTE ABDOMEN - pain, rebound tenderness, guarding
Physical exam findings with an Upper GIB?
Tachycardia
Orthostatic/Supine Hypotension
ACUTE ABDOMEN - pain, rebound tenderness, guarding
2 types of Stress ulcers
Curlings ulcers
Cushings ulcers
Curlings ulcers
Peptic ulcer due to extensive burns
Cushings ulcers
Peptic ulcer due to severe brain injury and other CNS lesions
Besides Curlings and Cushings ulcers, what else can cause stress ulcers?
Severe medical or surgical illnesses
In very ill patients, it is important to prevent stress ulcers. 2 ways to do that?
Enteral nutrition
Proton pump inhibitor
Esophageal varices usually develop secondary to?
Cirrhosis (portal hypertension)
4 things that increase the risk of bleeding with esophageal varices?
- Size of varices
- Presence of Red Wale Markings
- Severity of liver disease
- Active alcohol abuse
4 things that increase the risk of bleeding with esophageal varices?
- Size of varices
- Presence of Red Wale Markings
- Severity of liver disease
- Active alcohol abuse
Red wale markings are what and are seen with?
- seen with esophageal varices with increased risk of bleeding
= longitudinal dilated venules
2 prevention items for Esophageal varices?
Beta - adrenergic blockers
Band ligation
What is and is not seen with Hemorrhagic Erosive Gastritis?
Coffee ground emesis and NO inflammation on histological exam
What is and is not seen with Hemorrhagic Erosive Gastritis?
Coffee ground emesis and NO inflammation on histological exam
Zollinger-Ellison Syndrome
Primary Gastrinoma - gastrin secreting tumor
Gastrin secreting tumor?
Zollinger-Ellison Syndrome
Presentation of Zollinger-Ellison Syndrome?
Severe, recurrent PUD not responding to treatment
If Zollinger-Ellison syndrome is associated with MEN1 syndrome, what other symptoms are present?
Hyperparathyroidism
Pituitary neoplasm
What is seen on EGD with Zollinger-Ellison syndrome?
Large mucosal folds
With Zollinger-Ellison syndrome, serum gastrin is above?
1000
Treatment for Zollinger Ellison Syndrome?
Surgical resection
The secretin stimulation test can diagnose?
Zollinger-Ellison syndrome
What is a Mallory Weiss Tear?
Superficial tear at the gastroesophageal junction
Superficial tear at the gastroesophageal junction caused by vomiting ,retching, coughing?
Mallory Weiss Tear
Treatment for Mallory Weiss Tear?
Nothing - bleeding usually stops spontaneously
Boerhaave Syndrome
Transmural tear at the gastroesophageal junction
Most common site of a Dieulafoy lesion?
Stomach
Dieulafoy lesion
Aberrant large-caliber submucosal artery
GAVE
Gastric Antral Vascular Ectasias
“Watermelon stomach”
GAVE
- Gastric Antral Vascular Ectasias
What is GAVE?
Multiple superficial telangiectasias in antrum of stomch
What is GAVE?
Multiple superficial telangiectasias in antrum of stomach
