Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Emergency Medicine Assistantship > GI Emergencies > Flashcards

GI Emergencies Flashcards

(65 cards)

Start Studying
1
Q

In which ways can an acute GI bleed present?

A

Haematemesis, coffee ground vomit, and melaena

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Which is more common - an upper GI bleed or a lower GI bleed?

A

Upper, by about 4 times.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the most important factor in prognosis following a GI bleed?

A

The size of the vessel affected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the most common cause of an acute upper GI bleed?

A

Peptic ulcers and oesophago-gastric varices.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Other than peptic ulcers and oesophageal varices, what are some causes of an upper GI bleed?

A
  • Gastritis
  • Duodenitis
  • Portal hypertensive gastropathy
  • Malignancy
  • Mallory-Weiss tear
  • Vascular malformation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

If peptic ulcer disease is suspected as the cause of an upper GI bleed, what factors in the history might support that diagnosis?

A
  • Alcohol abuse
  • Chronic renal failure
  • NSAIDs
  • Increasing age
  • Low socio-economic class
  • Hx of H. pylori
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How can the severity of a GI bleed be assessed initially?

A

By the extent of the blood loss and degree of shock.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What does haematemesis usually indicate?

A

Active haemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What does coffee-ground vomit usually indicate?

A

Bleeding has ceased, is modest, or lower upper GI.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What does melaena usually indicate?

A

Upper GI bleed, but also possible to be from small bowel or right side of colon.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is a Mallory-Weiss tear?

A

A tear of the lower oesophagus usually secondary to chronic excessive coughing or vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What signs of shock due to an acute bleed might be found on examination?

A 
Hypotension
Tachycardia
Pallor
Postural drop
Cool extremities
Chest pain
Confusion
Oliguria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

If an acute bleed has a chronic background, what additional signs might be elicited on examination?

A

Pallor and signs of anaemia
Evidence of dehydration
Stigmata of liver disease or signs of a tumour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the primary investiagtion with an acute GI bleed?

A

Endoscopy - oesophagogastroduodenoscopy for upper, and flexible sigmoscopy for lower GI bleed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How quickly should endoscopy be performed on a pt with an acute GI bleed?

A

Immediately after resus if severe and acute, but within 24 hours of admission for all other UGI bleeds.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which blood tests should be ordered on a pt with an acute gi bleed? Justify each answer.

A
  • FBC mainly for Hb
  • Cross match - 2-6 units
  • Coagulation profile and INR
  • LFTs (underlying liver disease)
  • U&Es (nitrogen:creatitine ratio, AKI)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What use would a CXR be in a pt with an acute upper GI bleed?

A

Can be used to exclude perforated viscus/ileus if performed upright.

Also can rule out aspiration and perforated oesophagus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the way to remember management for an acute GI bleed?

A

8Cs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the 8Cs of an acute GI bleed?

A
  • Crossmatch
  • Cannulate x2
  • Coagulation screen
  • Crystalloids
  • Catheter
  • Cold-prick drugs (warfarin etc)
  • Camera (OGD)
  • Call surgeons and for help!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the 2 scoring systems for acute upper GI bleeds?

A
  • Blatchford at first assessment

- Rockall score after endoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

A score of what on the Blatchford risk assessment indicates a pt needs intervention?

A

Anything more than zero.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

A score of what on the Rockall scale indicates a pt should be investiagted with endoscopy?

A

Anything more than zero.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What techniques are used to treat non-variceal bleeds once they are visualised on endoscopy?

A
  • Clips +/- adrenaline
  • Thermal coag + adrenaline
  • Fibrin/thrombin + adrenaline
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What techniques are used to treat variceal bleeds once they are visualised on endoscopy?

A
  • Terlipressin at presentation
  • Balloon tamponade
  • Band ligation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What benign anorectal pathology might cause a PR bleed?
Haemorrhoids Anal fissure Fistula-in-ano
26
What benign colonic pathology might cause a PR bleed?
Diverticular disease | IBD
27
What malignant/premalignant pathology might cause a PR bleed?
Polyps | Colorectal or anal cancer
28
How can a PR bleed present?
Anywhere on the spectrum between occult, moderate, and massive bleeding.
29
What red flags with PR bleeding would make you suspect a malignant cause?
``` Unexplained weight loss Change in bowel habit Tenesmus FHx PMHx ```
30
How does retal bleeding tend to present wrt the amount of blood?
1 of 3 ways: 1. Occult i.e. with anaemia 2. Moderate e.g. small amounts visible in stool 3. Massive bleeding with signs of shock
31
Where is it likely to have come from if a PR bleed is: 1. Bright fresh blood? 2. Blood mixed with stool? 3. Tar-like faeces?
1. Lower down in GI tract 2. Higher GI tract, middle ground 3. Upper GI tract
32
O/E of a pt with PR bleeding, what focussed points can be examined?
- Pallor/anaemia - Signs of shock - Cachexia/weight loss - Abdominal masses - PR for any obvious pathology
33
What baseline bloods are important for GI bleeds?
- FBC - Iron studies - Clotting - LFTs
34
Which additional test can be performed in a young pt with a GI bleed, and why?
Faecal calprotectin as it is a useful screen for IBD.
35
What are the 2 categories of abdominal trauma?
Blunt and penetrating
36
Which organs are most commonly dama n blunt abdominal trauma?
Liver and spleen
37
What mechanisms are common for blunt abdominal trauma?
Blow from an external object e.g. seatbelt Deceleration forces I.e. very common in RTCs
38
What might cause trauma penetrating the abdomen?
Gunshot, shrapnel, stab wound, RTC... loads of ways
39
Which observation measured out of hospital is a sign of more significant intra-abdominal injuries?
Hypotension
40
If a patient has had blunt trauma to the abdomen, but has no signs on examination, can we send them home?
No - they need serial examinations and imaging to exclude occult injuries.
41
What is the seat-belt sign?
Bruising across site of lap portion of seatbelt that has high levels of association with abdominal organ damage.
42
Which organ is most at risk in children who have the seatbelt sign?
Pancreas
43
Following abdomina trauma, what might abdominal breathing pattern indicate?
Spinal cord injury
44
What is Cullen's sign?
Periumbilical eccymosis indicating retroperitoneal haemorrhage
45
A patient who has been in an RTC has abdominal trauma. They have signs of peritonitis. What is the cause likely to be if this is noted: 1. immediately? 2. 5 hours after the incident?
1. Leakage of intestinal contents | 2. Intra-abdominal haemorrhage
46
What bedside tests are important in abdominal trauma?
- Glucose levels - Urinalysis - Pregnancy test
47
Which imaging investiagtion is used in haemodynamically unstable trauma patients?
FAST - Focused abdominal sonography for trauma
48
Which imaging investiagtion is used in haemodynamically stable trauma patients?
CT abdomen
49
Why is acute pancreatitis so painful?
Inflammation of pancreas causes exocrine enzyme release which autodigests the pancreas.
50
What are the top 2 causes of acute pancreatitis?
Gallbladder disease | Excess alcohol consumption
51
How do gallstones cause pancreatitis?
Blockage of the bile duct, which creates back-pressure into the pancreatic duct
52
What is the acronym for the causes of pancreatitis?
GET SMASHED
53
What are the causes of pancreatitis according to the GET SMASHED acronym?
``` Gall stones Ethanol Trauma Steroids Mumps Autoimmune Scorpion poison Hypercalcaemia/Hypercholesterolaemia/Hypothermia ERCP Drugs ```
54
Which drugs can cause acute pancreatitis?
Thiazides Sodium valproate Azathioprine
55
A man comes to A&E with sudden onset severe abdominal pain an vomiting, which radiates to his back. What blood test should we 100% do?
Amylase!
56
A man comes to A&E with sudden onset severe abdominal pain an vomiting, which radiates to his back. How should this patient be assessed initially?
ABCDE assessment
57
A man comes to A&E with sudden onset severe abdominal pain an vomiting, which radiates to his back. What sign can we look for on examination that might suggest origin in the bile duct?
Presence of jaundice
58
What are the worrying signs on examination of a patient with ?pancreatitis?
- Gross hypotension - Pyrexia - Tachypnoea - Ascites - Pleural effusion - Cullen's sign or Grey Turner's sign
59
What amylase suggests acute pancreatitis?
Rasied 3 times upper limit of normal
60
A man comes to A&E with sudden onset severe abdominal pain an vomiting, which radiates to his back. What are your top differentials that need ruling out?
Pancreatitis Small bowel perforation/obstruction Ruptured or dissecting AA Atypical MI
61
How is the severity of pancreatitis measured?
Using the Glasgow score
62
How does the Glasgow score measure prognosis in pancreatitis?
Point for: - Age over 55 - WCC over 15 - Urea over 16 - Glucose over 10 - pO2 under 8 - Albumin under 32 - Calcium under 2 - LDH over 600 - AST/ALT over 200 3 or more indicates severe pancreatitis
63
How should mild pancreatitis cases be managed?
``` Supportively: -Analgesia -IV fluids if NBM Abx if specific infection present NG tube if severe vomiting Treat the cause e.g. bile duct clearance if gallstones cause. ```
64
How should severe pancreatitis cases be managed?
- ITU/HDU admission - IV abx for pancreatic necrosis - Enteral nutrition (NG tube inserted into the jejunum) - Surgery for infection and necrosis
65
What are the complications of acute pancreatitis?
- Pancreatic necrosis - Infected necrosis - Acute fluid collections - Pancreatic abscess - Acute cholecystitis - Systemic complications

Emergency Medicine Assistantship (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions