Surgery 06: Upper Gi Bleeding

Front 1

2 kinds of UGI hemorrhage

Back 1

nonvariceal
variceal

Front 2

nonvariceal is ___% of all UGI hemorrhage

Back 2

80

Front 3

top 4 causes of nonvariceal UGI hemorrhage

Back 3

PUD
Mallory-Weiss
gastritis/duodenitis
esophagitis

Front 4

2 arteries responsible for PUD hemorrhages

Back 4

left gastric a.
duodenal a.

Front 5

resuscitation steps for UGI hemorrhage (4)

Back 5

2 large bore IVs
Foley cath
NGT
PR

Front 6

blood tests to take during resuscitation (4)

Back 6

CBC
cross-match
PT/PTT
LFTs

Front 7

first step post resuscitation for UGI hemorrhage

Back 7

EGD

Front 8

if EGD finds active bleeding or ___, do ___.

Back 8

high risk of rebleeding
attempt endoscopic tx

Front 9

risk of rebleeding is given by ___ grades

Back 9

Forrest

Front 10

Forrest grades ___ (3) correspond to high risk of rebleeding

Back 10

I
IIa
IIb

Front 11

3 kinds of endoscopic tx

Back 11

ephinephrine injection
thermal tx
hemoclips

Front 12

2 kinds of thermal tx

Back 12

electrocautery
argon plasma

Front 13

if endoscopic tx is successful, do ___ (4)

Back 13

monitor
investigate HP status & treat
PPIs
stop ulcerogenic meds

Front 14

tx for H pylori (3)

Back 14

Metronidazole
Omeprazole
Clarithromycin

Front 15

2 popular ulcerogenic meds

Back 15

NSAIDs
SSRIs

Front 16

if EGD shows a low grade lesion, do ___ (4)

Back 16

monitoring
investigate HP status
give PPI
discontinue ulcerogenic meds

Front 17

if rebleeding occurs after successul endoscopic tx, retry it ___ more times before proceeding to ___

Back 17

1
surgery

Front 18

5 indications for surgery for UGI hemorrhage

Back 18

shock
hemodynamic instability after consumption of >6 units of blood
slow bleeding consuming >3 units of blood/day
recurrent bleeding after endoscopic tx
failure of endoscopic tx

Front 19

3 parts of surgery for bleeding duodenal ulcer

Back 19

exposure
hemostasis
reduce acid secretion

Front 20

exposure in surgery for bleeding duodenal ulcer is via ___

Back 20

longitudinal duodenotomy

Front 21

hemostasis in surgery for bleeding duodenal ulcer: ___ then ___

Back 21

apply direct pressure
suture

Front 22

acid reduction in surgery for bleeding duodenal ulcer

Back 22

truncal vagotomy with pyloroplasty

Front 23

surgery for bleeding gastric ulcer for low-risk patients

Back 23

distal gastrectomy

Front 24

surgery for bleeding gastric ulcer for high-risk patients (2)

Back 24

ulcer resection
vagotomy with pyloroplasty

Front 25

Mallory-Weiss tears are usually at ___

Back 25

GE junction

Front 26

tx for Mallory-Weiss bleeding: first try ___, then ___, then ___.

Back 26

EGD
angio embolization
surgery

Front 27

surgery for Mallory-Weiss (2)

Back 27

high gastrotomy
suturing

Front 28

first 2 steps in managing variceal bleeding

Back 28

ABCs
resuscitation

Front 29

in variceal bleeding, after resuscitation give ___. this causes ___.

Back 29

octreotide
splanchnic vasconstriction

Front 30

in variceal bleeding, after giving octreotide do ___.

Back 30

EGD

Front 31

EGD tx for variceal bleeding (2)

Back 31

band ligation
sclerotx

Front 32

if EGD tx for variceal bleeding succeeds, ___ (5)

Back 32

continue octreotide
broad spectrum ABs
repeat EGD banding
nonselective beta blocker
PPI

Front 33

octreotide for variceal bleeding is for ___ days
ABs are for ___ days
banding is repeated every ___ days

Back 33

3--5
7
14

Front 34

if EGD tx for variceal bleeding fails, do one of ___ (3)

Back 34

Sengstaken-Blakemore tamponade
TIPS
surgical decompression

Front 35

inflate ___ part of Blakemore tube first

Back 35

gastric