Upper GIB

Question 1

What classifies a bleed as an Upper GIB?

Answer 1

Source is proximal to the ligament of Treitz

Question 2

What is the most common cause of an Upper GIB?

Answer 2

PUD

Question 3

Hematemesis

Answer 3

Vomit is bright red

“coffee ground” emesis

Question 4

Melena

Answer 4

Dark stool, develops with small amounts of blood

Question 5

Hematochezia

Answer 5

Bright red stool, MASSIVE GIB

Question 6

How will a Massive GIB present?

Answer 6

Hematochezia

Question 7

4ish co-morbid conditions that occur with Upper GIB?

Answer 7

Aortic Stenosis and renal disease
Smoking and liver disease
Alcohol abuse
H. Pylori and NSAIDs

Question 8

4ish co-morbid conditions that occur with Upper GIB?

Answer 8

Aortic stenosis and renal disease
Smoking and liver disease
Alcohol abuse
H. Pylori and NSAIDs

Question 9

Physical exam findings with an Upper GIB?

Answer 9

Tachycardia
Orthostatic/Supine Hypotension
ACUTE ABDOMEN - pain, rebound tenderness, guarding

Question 10

Physical exam findings with an Upper GIB?

Answer 10

Tachycardia
Orthostatic/Supine Hypotension
ACUTE ABDOMEN - pain, rebound tenderness, guarding

Question 11

2 types of Stress ulcers

Answer 11

Curlings ulcers

Cushings ulcers

Question 12

Curlings ulcers

Answer 12

Peptic ulcer due to extensive burns

Question 13

Cushings ulcers

Answer 13

Peptic ulcer due to severe brain injury and other CNS lesions

Question 14

Besides Curlings and Cushings ulcers, what else can cause stress ulcers?

Answer 14

Severe medical or surgical illnesses

Question 15

In very ill patients, it is important to prevent stress ulcers. 2 ways to do that?

Answer 15

Enteral nutrition

Proton pump inhibitor

Question 16

Esophageal varices usually develop secondary to?

Answer 16

Cirrhosis (portal hypertension)

Question 17

4 things that increase the risk of bleeding with esophageal varices?

Answer 17

1. Size of varices
2. Presence of Red Wale Markings
3. Severity of liver disease
4. Active alcohol abuse

Question 18

4 things that increase the risk of bleeding with esophageal varices?

Answer 18

1. Size of varices
2. Presence of Red Wale Markings
3. Severity of liver disease
4. Active alcohol abuse

Question 19

Red wale markings are what and are seen with?

Answer 19

• seen with esophageal varices with increased risk of bleeding
  = longitudinal dilated venules

Question 20

2 prevention items for Esophageal varices?

Answer 20

Beta - adrenergic blockers

Band ligation

Question 21

What is and is not seen with Hemorrhagic Erosive Gastritis?

Answer 21

Coffee ground emesis and NO inflammation on histological exam

Question 22

What is and is not seen with Hemorrhagic Erosive Gastritis?

Answer 22

Coffee ground emesis and NO inflammation on histological exam

Question 23

Zollinger-Ellison Syndrome

Answer 23

Primary Gastrinoma - gastrin secreting tumor

Question 24

Gastrin secreting tumor?

Answer 24

Zollinger-Ellison Syndrome

Question 25

Presentation of Zollinger-Ellison Syndrome?

Answer 25

Severe, recurrent PUD not responding to treatment

Question 26

If Zollinger-Ellison syndrome is associated with MEN1 syndrome, what other symptoms are present?

Answer 26

Hyperparathyroidism | Pituitary neoplasm

Question 27

What is seen on EGD with Zollinger-Ellison syndrome?

Answer 27

Large mucosal folds

Question 28

With Zollinger-Ellison syndrome, serum gastrin is above?

Answer 28

1000

Question 29

Treatment for Zollinger Ellison Syndrome?

Answer 29

Surgical resection

Question 30

The secretin stimulation test can diagnose?

Answer 30

Zollinger-Ellison syndrome

Question 31

What is a Mallory Weiss Tear?

Answer 31

Superficial tear at the gastroesophageal junction

Question 32

Superficial tear at the gastroesophageal junction caused by vomiting ,retching, coughing?

Answer 32

Mallory Weiss Tear

Question 33

Treatment for Mallory Weiss Tear?

Answer 33

Nothing - bleeding usually stops spontaneously

Question 34

Boerhaave Syndrome

Answer 34

Transmural tear at the gastroesophageal junction

Question 35

Most common site of a Dieulafoy lesion?

Answer 35

Stomach

Question 36

Dieulafoy lesion

Answer 36

Aberrant large-caliber submucosal artery

Question 37

GAVE

Answer 37

Gastric Antral Vascular Ectasias

Question 38

"Watermelon stomach"

Answer 38

GAVE | - Gastric Antral Vascular Ectasias

Question 39

What is GAVE?

Answer 39

Multiple superficial telangiectasias in antrum of stomch

Question 40

What is GAVE?

Answer 40

Multiple superficial telangiectasias in antrum of stomach