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UGIB Flashcards

1
Q

UGIB

A

Bleeding into the lumen of the proximal GI tract, proximal to the ligament of Treitz

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2
Q

UGIB signs and symptoms

A

Hematemesis, melena, syncope, shock, fatigue, coffee-ground emesis,
hematochezia, epigastric discomfort, epigastric tenderness, signs of hypovolemia, guaiac-positive stools

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3
Q

PUD

A

MC cause of significant UGIB

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4
Q

Bacteria associated w/ PUD

A

H. pylori

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5
Q

Treatment PUD

A

MOC - metronidazole, omeprazole, clarithromycin

ACO - ampicillin, clarithromycin, omeprazole

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6
Q

Valentino’s sign

A

RLQ pain/peritonitis as a result of succus collecting

from a perforated peptic ulcer

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7
Q

Duodenal Ulcers

A

pain relieves by food

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8
Q

Cause of DU

A

increased production of gastric acid

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9
Q

DU associated syndrome

A

Zollinger-Ellison syndrome

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10
Q

DU risk factors

A

Male gender, smoking, aspirin and other NSAIDs, uremia, Z-E syndrome, H. pylori, trauma, burn injury

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11
Q

DU symptoms

A 
Epigastric pain—burning or aching, usually several hours after a meal (food, milk, or antacids initially relieve pain)
Bleeding
Back pain
Nausea, vomiting, and anorexia
↓ appetite
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12
Q

DU signs

A 
tenderness in epigastric area (possibly)
guaiac-positive stool
melena
hematochezia
hematemesis
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13
Q

EGD findings associated w/ rebleeding

A

Visible vessel in the ulcer crater, recent clot, active oozing

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14
Q

DU medical treatment

A

PPIs (proton pump inhibitors) or H2 receptor antagonists—heal ulcers in
4 to 6 weeks in most cases

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15
Q

DU indications for surgery

A

Intractability
Hemorrhage (massive or relentless)
Obstruction (gastric outlet obstruction)
Perforation

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16
Q

Artery involved in bleeding duodenal ulcers

A

Gastroduodenal artery

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17
Q

Truncal vagotomy

A

Pyloroplasty

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18
Q

Duodenal perforation

A

Graham patch (poor candidates, shock, prolonged perforation)

Truncal vagotomy and pyloroplasty incorporating ulcer

Graham patch and highly selective vagotomy

Truncal vagotomy and antrectomy (higher mortality rate, but lowest recurrence rate)

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19
Q

DU intractability

A

PGV (highly selective
vagotomy)
vagotomy and pyloroplasty
Vagotomy and antrectomy BI or BII (especially if there is a coexistent pyloric/prepyloric ulcer) but associated with a higher mortality

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20
Q

Ulcer operation has the HIGHEST ulcer recurrence

rate and the LOWEST dumping syndrome rate

A

PGV (proximal gastric vagotomy)

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21
Q

Ulcer operation has

the LOWEST ulcer recurrence rate and the HIGHEST dumping syndrome rate

A

Vagotomy and antrectomy

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22
Q

Why must you perform a
(pyloroplasty, antrectomy)
after a truncal vagotomy?

A

Pylorus will not open after a truncal drainage procedure vagotomy

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23
Q

DU with lowest mortality rate

A

PGV (1/200 mortality), truncal vagotomy and pyloroplasty (1–2/200), vagotomy and antrectomy (1%–2% mortality)

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24
Q

Gastric Ulcers

A

40–70 years old (older than the duodenal ulcer population)

food increases GU pain

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25
Cause of GU
DECREASED CRYOPROTECTION or gastric | protection (i.e., decreased bicarbonate/ mucous production)
26
GU associated increased gastric acid
prepyloric pyloric coexist w/ DU
27
GU risk factors
Smoking, alcohol, burns, trauma, CNS tumor/trauma, NSAIDs, steroids, shock, severe illness, male gender, advanced age
28
GU symptoms
Epigastric pain | +/-Vomiting, anorexia, and nausea
29
GU diagnosis
History, PE, EGD with multiple biopsy (r/o gastric cancer)
30
GU MC location
lesser curvature - 70%
31
Options for concomitant duodenal and gastric ulcers
Resect (BI, BII) and TRUNCAL VAGOTOMY
32
Common option for surgical treatment of a PYLORIC gastric ulcer?
Truncal vagotomy and antrectomy (i.e., BI or BII)
33
Common option for a poor operative candidate | with a perforated gastric ulcer
Graham patch
34
Cushing ulcer
PUD/gastritis associated with NEUROLOGIC TRAUMA/TUMOR
35
Curling's ulcer
PUD/gastritis associated with MAJOR BURN INJURY
36
Marginal ulcer
Ulcer at the margin of a GI anastomosis
37
Dieulafoy’s ulcer
Pinpoint gastric mucosal defect bleeding from an underlying VASCULAR MALFORMATION
38
Perforated Peptic Ulcer
Acute onset of upper abdominal pain
39
Perforated Peptic Ulcer signs
Decreased bowel sounds tympanic sound over the liver (air) peritoneal signs tender abdomen
40
Signs of posterior duodenal erosion/ perforation
Bleeding from gastroduodenal artery (and possibly acute pancreatitis)
41
Sign indicates anterior duodenal perforation
Free air (anterior perforation is more common than posterior)
42
Perforated Peptic Ulcer associated lab findings
Leukocytosis | high amylase serum (secondary to absorption into the blood stream from the peritoneum)
43
Perforated Peptic Ulcer initial treatment
NPO: NGT (↓ contamination of the peritoneal cavity) IVF/Foley catheter Antibiotics/PPIs Surgery
44
Piece of omentum incorporated into the suture closure of perforation
Graham patch
45
Surgical options for treatment of a duodenal perforation?
Graham patch (open or laparoscopic) Truncal vagotomy and pyloroplasty incorporating ulcer Graham patch and highly selective vagotomy
46
Surgical options | for perforated gastric ulcer?
Antrectomy incorporating perforated ulcer, Graham patch or wedge resection in unstable/poor operative candidates
47
Significance of hemorrhage and perforation with duodenal ulcer?
may indicate two ulcers (kissing); posterior is bleeding and anterior is perforated with free air
48
Graham patch
For treatment of DUODENAL PERFORATION in poor operative candidates/unstable patients Place viable omentum over perforation and tack into place with sutures
49
Truncal vagotomy
Resection of a 1- to 2-cm segment of each vagal trunk as it enters the abdomen on the distal esophagus, decreasing gastric acid secretion
50
Other procedure must be performed along with a truncal vagotomy?
“Drainage procedure” (pyloroplasty, antrectomy, or gastrojejunostomy), because vagal fibers provide relaxation of the pylorus, and, if you cut them, the pylorus will not open
51
Vagotomy and Pyloroplasty
Pyloroplasty performed with vagotomy to compensate for decreased gastric emptying
52
Vagotomy and antrectomy
Remove antrum and pylorus in addition to vagotomy; reconstruct as a Billroth I or II
53
Advantage of proximal gastric vagotomy (highly selective vagotomy)
No drainage procedure is needed; vagal fibers to the pylorus are preserved; rate of dumping syndrome is low
54
Billroth I
Truncal vagotomy, antrectomy, and gastroduodenostomy
55
Billroth I Contraindications
Gastric cancer or suspicion of gastric cancer
56
Billroth II
Truncal vagotomy, antrectomy, and gastrojejunostomy
57
Kocher Maneuver
Dissect the left lateral peritoneal attachments to the duodenum to allow visualization of posterior duodenum
58
Stress gastritis
SUPERFICIAL mucosal erosions in the stressed patient
59
Stress gastritis Risk factors
Sepsis, intubation, trauma, shock, burn, brain injury
60
Stress gastritis prophylactic treatment
H2 blockers, PPIs, antacids, sucralfate
61
Stress gastritis signs and symptoms
NGT blood (usually), painless (usually)
62
Stress gastritis diagnosis
EGD - if bleeding is significant
63
Stress gastritis treatment
LAVAGE out blood clots, give a maximum dose of PPI in a 24-hour IV drip
64
Mallory Weiss Syndrome
Post-retching, postemesis longitudinal tear (submucosa and mucosa) of the stomach near the GE junction ~ 3/4 are in the stomach d.t. Increased gastric pressure, often aggravated by hiatal hernia
65
Mallory Weiss Syndrome Risk Factors
Retching, alcoholism (50%), 50% of patients have hiatal hernia
66
Mallory Weiss Syndrome symptoms
epigastric pain thoracic substernal pain emesis hematemesis
67
Mallory Weiss Syndrome diagnosis
EGD
68
Mallory Weiss Syndrome "classic" history
Alcoholic patient after binge drinking— first, vomit food and gastric contents, followed by forceful retching and bloody vomitus
69
Mallory Weiss Syndrome "classic" treatment
Room temperature water lavage (90% of patients stop bleeding) electrocautery arterial embolization surgery for refractory bleeding
70
Esophageal Variceal Bleeding
Bleeding from formation of esophageal varices from back up of portal pressure via the coronary vein to the submucosal esophageal venous plexuses secondary to portal hypertension from liver cirrhosis 2/3 of patients with portal thirds” of esophageal hypertension develop esophageal varices 2/3 of patients with esophageal varices bleed
71
Esophageal Variceal Bleeding signs and symptoms
``` Liver disease portal hypertension hematemesis caput medusa ascites ```
72
Esophageal Variceal Bleeding diagnosis
EGD
73
Esophageal Variceal Bleeding medical treatment
Lower portal pressure with somatostatin and vasopressin
74
Esophageal Variceal Bleeding surgical options
Sclerotherapy or band ligation via endoscope TIPS liver transplant
75
Sengstaken- Blakemore balloon
Tamponades with an esophageal balloon and a gastric balloon
76
Boerhaave's syndrome
Postemetic esophageal rupture posterolateral aspect of the esophagus (on location? the left), 3 to 5 cm above the GE junction - MC location
77
Boerhaave's syndrome cause of rupture
Increased intraluminal pressure, usually caused by violent retching and vomiting
78
Boerhaave's syndrome associated risk
Esophageal reflux disease (50%)
79
Boerhaave's syndrome symptoms
Pain postemesis (may radiate to the back, dysphagia)
80
Boerhaave's syndrome signs
``` Left pneumothorax Hamman’s sign left pleural effusion subcutaneous/mediastinal emphysema fever tachypnea tachycardia signs of infection by 24 hours neck crepitus widened mediastinum on CXR ```
81
Mackler's triad
emesis lower chest pain cervical emphysema (subQ air)
82
Hamman' sign
“Mediastinal crunch or clicking” produced by the heart beating against air-filled tissues
83
Boerhaave's syndrome treatment
Surgery within 24 hours to drain the mediastinum and surgically close the perforation and placement of pleural patch; broad spectrum antibiotics
84
MC cause of esophageal perforation
Iatrogenic (most commonly cervical esophagus)

SURGERY (27 decks)

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