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21 Cards in this Set
- Front
- Back
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What are the two most common causes of lower GI bleeding (LGIB)? |
Hemorrhoids Anal fissure |
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Other than local anal conditions, what are the other 4 most common causes of LGIB in adults? |
Diverticula Vascular ectasia (>70y/o) Neoplasms Colitis |
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True or False Hematemesis is always a presentation of upper GI bleeding (UGIB)? |
True |
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True or False Melena is always a presentation of UGIB? |
False A slow bleed from the LGI may take time to come out. |
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True or False Hematochezia is always a presentation of LGIB? |
False May be due to brisk UGIB or massive bleed. |
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Why are there hyperactive bowel sounds in GIB? |
Blood is an irritant to GIT |
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What is the main difference between hemorrhoid and anal fissure? |
Hemorrhoids are painless. Anal fissure are painful, due to constipation and tearing of the anus |
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What are the 3 predictors of re-bleeding and death in patients admitted for UGIB? |
1) Increasing age 2) Co-morbidities 3) Hemodynamic compromise (tachycardia or hypotension) |
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What positional test is contraindicated in patients with tachycardia/hypotension? What does postural hypotension mean in terms of volume of blood lost? |
Tilt test may precipitate myocardial infarction. Patient's with postural hypotension may already have lost 20% of blood volume. |
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What are the hemoglobin differences in acute vs chronic bleeding? |
Patients with acute bleeding have normal Hgb. Chronic bleeders have low Hgb and easy fatigability. May present with IDA, low MCV and increased RBC distribution width. |
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What is the best sign of restoration of adequate blood volume? |
50cc of urine output every hour |
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Pt is cold and clammy, with pallor, postural hypotension, persistent blood loss, inadequate urine output, drop in Hct. These are all signs of? What should be done? |
Signs of shock due to blood volume loss. Run fast drip plasma expanders through large bore needle. |
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What stool discolorations do the following drugs produce? a) Iron preparation b) Bismuth c) Rifampicin |
a) Black tarry stool with green tinge b) Black stool c) Orange to red discoloration |
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What drug or diet could a patient be on if they notice fatty/oily/orange stool that seeps out without notice? |
Olestra or Cod/Blue Marlin (gindara) |
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How can a Mallory-Weiss tear occur? |
Excessive alcohol consumption or bulimia leading to multiple bouts of vomiting produces the triangular shaped or longitudinal tears/lesions in the esophagus near the GEJ. Usually crosses the GEJ but may also be located in the proximal gastric mucosa. |
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Inspection reveals three surgical scars in the patient's abdoment - one in the umbilicus and two more to make a diamond approaching the right upper quadrant - what surgery did the patient have? |
Laparoscopy cholycystectomy |
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A chevron cut is indicative of what type of surgery? |
gastric or pancreatic surgery |
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Hyperpigmentation in the axilla, neck, and dorsum of hand. |
Acanthosis nigricans, sign of primary GI malignancy |
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What skin symptoms are associated with Peutz-Jeghers syndrome? |
Hyperpigmented lips and fingertips. GI bleeding may occur from hamartomatous polyps. |
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What two signs may indicate acute pancreatitis or pancreatic necrosis with retroperitoneal or intra-abdominal bleeding? |
Cullen's sign - hematoma around umbilicus Grey Turner's sign - hematoma on flanks |
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What sign on Virchow's node in the left supraclavicular fossa could signify gastric cancer? |
Troisier's sign is a finding of an enlarged and hardened node. |
