EGS

Question 1

What bleeding rate for GI bleeds can be detected by angiography?

Answer 1

0.5mL/hr

Question 2

What bleeding rate for GI bleeds can be detected by technetium99?

Answer 2

0.1mL/hr

Question 3

For GI bleeds which is more specific for localizing angiography or Tc-99?

Answer 3

angiography

Question 4

For GI bleeds which is more sensitive angiography or Tc-99?

Answer 4

technietium99

Question 5

What are the two most common reasons for GI bleed?

Answer 5

-erosive gastritis (was more common prior to PPIs)
-duodenal/gastric ulcers (together make 55%)

Question 6

What is the most common cause of a LGI bleed?

Answer 6

an UGI bleed

Question 7

What is the risk of rebleeding if EGD finds a pulsatile bleeding ulcer?

Answer 7

85%

Question 8

What is the risk of rebleeding if EGD finds a nonbleeding visible vessel?

Answer 8

40-50%

Question 9

What is the risk of rebleeding if EGD finds an adherent clot on an ulcer?

Answer 9

20-30%

Question 10

What is the risk of rebleeding if EGD find an oozing ulcer without a visible vessel?

Answer 10

< 20%

Question 11

What is the risk of rebleeding if EGD finds a flat blood spot at the base of an ulcer?

Answer 11

< 10%

Question 12

What is the risk of rebleeding if EGD finds a clean based ulcer?

Answer 12

< 5%

Question 13

What is the rebleed rate for UGI bleed when treated with angiography?

Answer 13

up to 50%

Question 14

When controlling a posterior duodenal bleeding ulcer where should the 3 sutures be placed?

Answer 14

superior, inferior, and to patient’s left (to get transverse pancreatic artery)
-use vicryl UR6

Question 15

What nonselective beta-blocker should be used in patients w/ esophageal varices?

Answer 15

-carvedilol (now)
-propranolol (historically)

Question 16

What percentage of patients get new or worsening hepatic encephalopathy with a shunt procedure for esophageal varices?

Answer 16

-10-30%
-because now venous blood carrying the toxins from the GI tract are in systemic circulation and bypassing the liver

Question 17

What are contraindications to shunt procedures for esophageal varices?

Answer 17

-elevated bilirubin
-elevated creatinine
-current hepatic encephalopathy refractory to medical management

Question 18

If TIPS is not available what is the preferred shunt procedure?

Answer 18

distal splenorenal shunt (shunt splenic vein to renal vein)

Question 19

What are the 3 most common causes of LGI bleed?

Answer 19

-diverticular disease (40%)
-inflammatory bowel disease (21%)
-neoplasia