Osce Upper Gi Bleed

Front 1

Fxn of ligament of treitz

Back 1

delineates UGI from LGI bleed. It is the reflection of the peritoneum that suspends the duodenojejunal flexure in its place (at the jxn between the 3rd 4th part of the duodenum, where it turns intraperitoneal)

Front 2

what is responsible for the black tarry stool seen in UGI bleeds

Back 2

blood entering GI tract prox to lig of treitz is exposed to higher levels of acidic digestive juices from stomach leading to oxygenation & denaturization of Hb

Front 3

Causes of UGI bleeds

Back 3

Epistaxis, Esophageal varices, Esophagitis, Mallory-Weis Tears, Boeerhave's Syndrome, Hematobillia, Aortoenteric Fistula, Cancer, Acute Gastritis, Stress Ulcers, Dieulafoy's Ulcer,

Front 4

Rx of esophageal varices

Back 4

Endoscopic variceal banding techniques

Front 5

Cause of esophageal varices

Back 5

chronic EtOH abuse; portal blood encounters elevated resistance when attempting to enter hepatic parenchyma & is shunted to a point of portosystemic anastamosis in the distal esophagus

Front 6

Esophagitis usually caused by

Back 6

GERD

Front 7

Mallory weis tears caused by...

Back 7

repeated retching & vomiting caused by barotraumas to distal esophageal mucosa

Front 8

Who do you see mallory weis tears in...

Back 8

Alcoholics, binge/purge bulimics & anorrhexics.

Front 9

Picture of mallory weis tears

Back 9

Pt. vomits once without blood, tear occurs, subsequent vomiting has blood in it

Front 10

What is boeerhave's syndrome

Back 10

Post emetic esophgeal rupture of ALL layers of the esophagus

Front 11

What does boeerhave's syndrome present as

Back 11

Sepsis, pleural effusion, mediastinitis (can see mediastinal widening on xray). Rx with surgery & broad spectrum abx tx

Front 12

pain awakes pt from sleep, alleviated with anatacids or food

Back 12

duodenal ulcers

Front 13

Posterior erosion in duodenal ulcer presents as...

Back 13

Syncope, tachycardia, hypotension, boring pain radiating to back d/t erosion of GASTRODUODENAL a.

Front 14

Anterior erosion presents with signs & sx of what?

Back 14

acute abdomen

Front 15

what is hematobilia & what is it due to?

Back 15

Iatrogenic usually d/t procedures in biliary tract & often in pts w/ liver d/o & def in vit K. blood is mixed w/ bile in biliary tract before entering duodenum

Front 16

Esophagitis usually caused by

Back 16

GERD

Front 17

Mallory weis tears caused by...

Back 17

repeated retching & vomiting caused by barotraumas to distal esophageal mucosa

Front 18

Who do you see mallory weis tears in...

Back 18

Alcoholics, binge/purge bulimics & anorrhexics.

Front 19

Picture of mallory weis tears

Back 19

Pt. vomits once without blood, tear occurs, subsequent vomiting has blood in it

Front 20

What is boeerhave's syndrome

Back 20

Post emetic esophgeal rupture of ALL layers of the esophagus

Front 21

pain awakes pt from sleep, alleviated with anatacids or food

Back 21

duodenal ulcers

Front 22

Posterior erosion in duodenal ulcer presents as...

Back 22

Syncope, tachycardia, hypotension, boring pain radiating to back d/t erosion of GASTRODUODENAL a.

Front 23

Anterior erosion presents with signs & sx of what?

Back 23

acute abdomen

Front 24

what is hematobilia & what is it due to?

Back 24

Iatrogenic usually d/t procedures in biliary tract & often in pts w/ liver d/o & def in vit K. blood is mixed w/ bile in biliary tract before entering duodenum

Front 25

what is aortoenteric fistula

Back 25

fistula between aorta & duodenum often post AAA repair with graft that got infected

Front 26

what is dieulafoys ulcer

Back 26

large submucosal a in gastric fundus erodes into gastric lumen w/o overlying ulceration.

Front 27

causes of UGI bleed in esophagus

Back 27

varices, esophagitis, mallory-weis, Boeerhaves, Paraesophogeal Hiatal Hernia, SCC, Perforation d/t instrument.

Front 28

causes of UGI bleed in stomach

Back 28

gastric ulcer, gastritis, gastric volvulus, NG tube irritation, dieulafoy ulcer, cancer

Front 29

caues of UGI bleed in duodenum

Back 29

duodenal ulcer, diverticula, AE fistula, Hematobilia

Front 30

pain caused by ingestion of food

Back 30

gastric ulcer

Front 31

work up for gastric ulcer

Back 31

Upper GI series with barium, endoscopy, gastric acid analysis

Front 32

Fxn of EGD

Back 32

visualize & bx for cancer or H. pylori

Front 33

Fxn of upright CXR in gastric ulcer workup

Back 33

see free air (if suspect perf)

Front 34

Rx of bleeding gastric ulcer

Back 34

NG Tube, prostglandin analogs (misoprostol) - increases mucosa, H2 antagonists - ulcer heals in 4-6 wks, antacids (controls gastric pH & promotes healing), sucralfate (coats ulcer), PPI's

Front 35

triple therapy for H. Pylori

Back 35

Metronidazole, TCN/Amp & bismuth sulfate

Front 36

Complications of gastric ulcers

Back 36

IHOP, intractability, hemorrhages (posterior duodenal ulcer d/t gastroduodenal aa), obstruction, perforation (anterior duodenal ulcer)

Front 37

way to rx duodenal perforation due to ulcer

Back 37

graham patch - viable piece of omentum placed over perforation

Front 38

Rx of ulcers

Back 38

Cut vagus nerves (MC)

Front 39

What is Truncal vagotomy?

Back 39

resection of each vagal trunk as it enters the abdomen & distal esophagus - dnervates most abdominal viscera, decmotility --< drainage procedures

Front 40

What is Selective vagotomy?

Back 40

- total denervation of stomach, including pylorus but sparing parasympathetic innervation but must do a drainage procedure

Front 41

What is Proximal gastric vagotomy?

Back 41

- dividing the branches of the vagus nerve that innervate the parietal cell mass along the lesser curvature --> can lead to dumping syndrome