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GI 2 > GI Emergencies > Flashcards

GI Emergencies Flashcards

1
Q

***Rule of thumb for (packed RBC) blood transfusion and amt Hb raised

A

each unit of blood raises Hb by 1-1.5g

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2
Q

At what Hb level should you ALWAYS transfuse?

A

if Hb less than 7

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3
Q

If hypOtensive or has CV (angina/CAD) disease, keep Hb at what level?

A

Hb 9-10g

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4
Q

LGIB - location and physical description

A

Distal to ligament of Treitz

-BRBPR (hematochezia)

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5
Q

Anion gap equation

A

(Na+) - (Cl- + HCO3-) = 12-16

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6
Q

High Anion gap due to…

A

MUDPILES - hypOperfusing muscles, so your body does lactic acidosis

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7
Q

What is diverticulosis, what location most common

A
  • Herniation of (sub)/mucosa thru muscle layers of colon.

- Left colon most common location

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8
Q

PAINLESS, copious hematochezia or maroon stools is most likely caused by what?

A

diverticulosis

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9
Q

NSAIDs/ASA increase risk of developing…?

A
  • 1-3x risk of diverticular bleed with NSAIDs/ASA
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10
Q

Tx of diverticulosis is?

A

endo-clipping

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11
Q

What is abdominal cramping, bloody diarrhea in a 50+yo?

A

Colitis - seen in ischemic colitis/IBD/infection

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12
Q

Ischemic colitis is associated with…

A

atherosclerosis

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13
Q

**4 causes of 80% of UGIB

A
  1. PUD (gastric or duodenal) - 40-50%
  2. Esophageal or gastric varices
  3. Erosive Esophagitis-gastritis
  4. Mallory Weiss Tear (5-10%)
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14
Q

**4 causes of 80% of LGIB

A
  1. Diverticulosis (30%)
  2. Colitis (24%) - includes ischemic, IBD, radiation
  3. Hemorrhoids - 14%
  4. Post polypectomy bleed - 8%
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15
Q

***Retching and dry heaves due to alcohol or vigorous coughing - what possibly results?

A

Mallory Weiss tear - NONtransmural tear of GE junction

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16
Q

**UGIB treatment

A

IV fluids

**Type/Cross match for packed RBCs TRANSFUSION

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17
Q

**How much blood is transfused for UGIB treatment?

A

2-6 units.

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18
Q

**Approximately how much does one unit of blood raise Hb? What is the ideal platelet count?

A

1-1.5grams Hb raised per one unit of blood

Ideal platelet count: 50,000+

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19
Q

**Below what amount of Hb do you always transfuse? What’s the goal in non-CV/hypotensive people? In CAD/angina/hypotensive patients?

A

less than 7gm. Goal is 8-9gm in non-CV/hypotensive. Keep at 9-10gm for CV-patients

20
Q

***List the clinical manifestations - signs and symptoms of appendicits

A
  1. Vague epigastric and periumbilical pain
  2. Discomfort shifts to RLQ associated
    N/V
  3. Pain worse: walking, coughing
  4. Low grade fever
21
Q

What type of atypical presentation of appendicitis is this?

Less abdominal pain, maybe right flank pain

A

Retrocecal appendix

22
Q

What type of atypical presentation of appendicitis is this?

Associated with pyuria or hematuria

A

Retroileal

23
Q

***Angiodysplasia often found in…

What type of bleeding does it cause?

A

cecum or ascending colon (RIGHT COLON)

Causes LGIB - most common cause of SI bleeds

24
Q

**What is the triad seen in elderly people that includes angiodysplasia?

A

Heyde Syndrome - angiodysplasia, Chronic Renal Failure, and Aortic Stenosis (systolic murmur radiating to carotid)

25
Q

***What type of vessels if angiodysplasia found in?

A

submucosal vessels - flat vessels radiating from center Right Colon

26
Q

**What is the cardinal appearance of angiodysplasia?

A

red stellate appearance

27
Q

Patient takes ASA, NSAIDs and has GI bleed - what’s the cause and UGIB and LGIB?

A
  • UGIB - due to PUD causing erosive gastritis (alcohol or stress may also induce this)
  • LGIB - diverticulosis
28
Q

Possibility of recurrent bleeding increases in PUD with what two situations?

A
  1. ulcer greater than 2cm

2. ulcer located on high on lesser curvature of stomach or in duodenum

29
Q

**Painless, large volume blood loss via hematochezia/maroon stools most commonly due to what? What location?

A

DiverticuLOSIS in left colon

30
Q

tx of diverticuLOSIS

A

endo-clipping

31
Q

abdominal cramping and bloody diarrhea

What is the ischemic version of this associated with?

A

colitis (ischemic colitis, IBD, infection)

Ischemic associated with atherosclerosis

32
Q

**Capsule endoscopy is good for what? If this doesn’t find a bleed, what do you do next?

A

LGIB with unknown location - good for SI occult bleeding, 83% diangostic. If negative, do a tagged RBC scan.

33
Q

When is surgery indicated in LGIB?

A

If interventional radiology/procedures failed or person requires 6+units of PRBC (blood) in 24hrs.

34
Q

CT imaging of pelvic inlet shows thickened wall with ___ ___ = appendicits?

A

calcified appendicolith

35
Q

Name the four signs likely seen with tenderness and guarding of RLQ.

A

This is acute appendicits

  1. McBurneys - tenderness midway between right umbilicus and ASIS
  2. Rovsing - rebound pressure on left side
  3. Psoas - Person on left side, pain on passive hyeprextension of right hip
  4. Obturator - pain on passive flexion and IR of R hip
36
Q

When are CT-scans contraindicated?

A

In pregnant women with suspsected appendicitis, so use US

37
Q

labs for appendicitis

A

leukocytosis (>11), postive CRP

38
Q

High fever, diffuse abdominal tenderness, palpable mass, marked leukocytosis - suspect what?

A

perforated appendicitis

39
Q

Tx of perforated appendicitis is?

A

emegent laparoscopic appendectomy

40
Q

Pain is “all over abdomen”, not localized. Decreased bowel sounds, distended, spasms taught BOARD-LIKE RIGIDITY, rebound tenderness. (also hypoT, tachycardia, sepsis, shock)

A

acute abdominal viscus perforation - Perforated Peptic-Gastric-Duodenal Ulcer

41
Q

Free air under diaphragm indicates

A

acute abdominal viscus perforation - Perforated Peptic-Gastric-Duodenal Ulcer

42
Q

Where do Perforated Peptic-Gastric-Duodenal Ulcer normally form?

A

When gastric contents spill into peritoneal cavity - usually from ulcer on ANTERIOR WALL of stomach or duodenum

43
Q

Lab findings for acute abdominal viscus perforation

A

leukocytosis, left shift, increased amylase, increased CRP

44
Q

Occult bleed in males

A

may cause iron deficiency anemia (IDA-men); always GIB or renal blood loss until proven otherwise

45
Q

***treat varices with what?

A

octreotide

46
Q

If pt need transfusion and has coagulopathy, consider what?

why begin PPI?

A

fresh frozen plasma and Vit K.

PPI promotes platelet aggregation

GI 2 (9 decks)

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