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45 Cards in this Set

  • Front
  • Back
The acute intervention necessary for successful outcome requires a close cooperative team effort involving the emergency physician, gastroenterologist, interventional radiologist and the surgeon
T or F
Medications such as _________ and certain _________ can blunt the normal physiologic tachacardic response to the hypovolemia that occurs with bleeding
beta blockers
calcium channel blockers
Hematemesis is when blood is lost from the _______ tract accumulating in the stomach RAPIDLY the associated emesis is red blood
upper GI
coffee ground emisis is the result of SLOWER _______ bleeding or stagnation of blood secondary to the presence of partially digested blood
upper GI
Hematochezia is the passage of bright red blood in the patients stool or per rectum without stool. This represents the presence of _______ GI Hemorrhage in 90% of cases.
Melena is black tarry stool, which results from bacterial degradation of hemoglobin to various hemochromes during its transit time through the small and large intestines is in most cases a sign of ______ GI hemorrhage.
The presence of only approximately ________ of blood is necessary to cause melena[test]
Upper GI Hemorrhage(75%) is bleeding occurring proximal to the _______. In the nonvariceal category peptic ulcer disease represents the most frequent etiology.
ligament of Trietz
Lower GI Hemorrhage(25%) is bleeding occurring _____ to the ligament of Trietz (distsl duodenum)
Three major questions have to be answered regarding the patient presenting to the Emergency Department with GI Hemorrhage.
Has the patient actually had a GI Hemorrhage?
Does it originate from the upper or lower tract?
If it is an upper GI Hemorrhage, is it variceal or nonvariceal?
If there is doubt about the origin of blood passed per rectum check the ______ GI tract first, this is more likely to be catastrophic
Esophageal varices are almost always associated with the clinical features of underlying________
liver disease
________ and ________are more common in the older population
Diverticular hemorrhage ischemic colitis
_________ and _______ occur more frequently in younger patients
Peptic ulcer disease esophagitis
Bleeding from a Meckel’s diverticuli occur more frequently in patients under ___ years of age
History of epigastric pain for some time that is transiently relieved by food ingestion would strongly suggest __________
duodenal peptic ulcer disease
If the patient has a history of prior AAA repair suspicion of __________ should be present
aortoenteric fistula
If there is a history of previous retching episodes followed by subsequent upper GI bleeding think _________ tear
The most frequent etiologies in these renal patients are _________ and angiodysplasia
peptic ulcer disease
History of decrease in appetite with weight loss and change in bowel habits should arouse suspicion of underlying gastrointestinal ___________
In the Catastrophic GI Hemorrhage, even if the pulse oximeter reading is normal you should do this
place pt on supplemental oxygen to maximize tissue oxygenation
Intravenous volume In the Catastrophic GI Hemorrhage, resuscitation should be initiated immediately with ____________
crystalloids(NS or LR)-no dextrose
The patient who continues to demonstrate hemodynamic instability after receiving an infusion of 2-3 liters of crystalloid should be considered for ________
__________ blood should be used when transfusion is immediately indicated and type specific or type and crossmatched blood is not available
O negative
In the Catastrophic GI Hemorrhage, __________ should be performed after each fluid bolus
vital signs and clinical status
In the Catastrophic GI Hemorrhage, Foley catheter to monitor urinary output and therefore indirectly __________
renal perfusion
Remember that the initial _____ obtained maybe normal even in the face of severe hypovolemic shock
More severe shock =
higher mortality rate
In many patients _______ is a late manifestation of shock and may not manifest until 30% of blood volume is lost
The earliest detectable sign of shock is the presence of ________
Esophageal varicies (is or is not) a contraindication to use of an NG tube
is not
A BUN-creatinine ratio found to be equal to or greater than 36 in the absence of renal failure is highly suggestive of an _______ GI Bleed
For the Catastrophic GI Hemorrhage, _________ have recently been shown in two well designed randomized double blind placebo controlled studies to produce improvement of outcome
Continuous infusion of Proton Pump Inhibitors(PPI)
_________ can be used in the catastrophic GI bleed as an adjunct to reduce bleeding in nonvariceal bleeds
Commonly used endoscopic treatment of esophageal verices
– variceal ligation – elastic band strangulation of varix
Pharmacologic therapy of Esophageal Varicies
Temporizing device to control hemorrhage in the face of a failure of octreotide and no immediate access to endoscopy or failure of endoscopy
Gastroesophageal Balloon Tamponade Devices
a. Stab wounds of the abdomen occur most commonly in the ___________
upper quadrants
with the left > right.(TEST)
Anterior stab wounds penetrate the peritoneum ____ of the time but inflect a visceral injury less than ____ of the time.(TEST
Abdominal entries from the flank and back penetrate the peritoneum up to ___ and ____ respectively.
The most commonly injured organs are the ____ and ____.
_______ is most important factor in tissue injury
Shotgun Wound Classification:
Type 1 wounds
tissue and deep fascia only
_________ occurs 65% of the time in documented visceral injuries.
Decreased or absent bowel sounds
radiologic technique useful for detecting free fluid-hemoperitoneum.