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35 Cards in this Set
- Front
- Back
2 kinds of UGI hemorrhage
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nonvariceal
variceal |
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nonvariceal is ___% of all UGI hemorrhage
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80
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top 4 causes of nonvariceal UGI hemorrhage
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PUD
Mallory-Weiss gastritis/duodenitis esophagitis |
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2 arteries responsible for PUD hemorrhages
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left gastric a.
duodenal a. |
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resuscitation steps for UGI hemorrhage (4)
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2 large bore IVs
Foley cath NGT PR |
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blood tests to take during resuscitation (4)
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CBC
cross-match PT/PTT LFTs |
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first step post resuscitation for UGI hemorrhage
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EGD
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if EGD finds active bleeding or ___, do ___.
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high risk of rebleeding
attempt endoscopic tx |
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risk of rebleeding is given by ___ grades
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Forrest
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Forrest grades ___ (3) correspond to high risk of rebleeding
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I
IIa IIb |
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3 kinds of endoscopic tx
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ephinephrine injection
thermal tx hemoclips |
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2 kinds of thermal tx
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electrocautery
argon plasma |
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if endoscopic tx is successful, do ___ (4)
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monitor
investigate HP status & treat PPIs stop ulcerogenic meds |
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tx for H pylori (3)
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Metronidazole
Omeprazole Clarithromycin |
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2 popular ulcerogenic meds
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NSAIDs
SSRIs |
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if EGD shows a low grade lesion, do ___ (4)
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monitoring
investigate HP status give PPI discontinue ulcerogenic meds |
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if rebleeding occurs after successul endoscopic tx, retry it ___ more times before proceeding to ___
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1
surgery |
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5 indications for surgery for UGI hemorrhage
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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 |
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3 parts of surgery for bleeding duodenal ulcer
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exposure
hemostasis reduce acid secretion |
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exposure in surgery for bleeding duodenal ulcer is via ___
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longitudinal duodenotomy
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hemostasis in surgery for bleeding duodenal ulcer: ___ then ___
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apply direct pressure
suture |
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acid reduction in surgery for bleeding duodenal ulcer
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truncal vagotomy with pyloroplasty
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surgery for bleeding gastric ulcer for low-risk patients
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distal gastrectomy
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surgery for bleeding gastric ulcer for high-risk patients (2)
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ulcer resection
vagotomy with pyloroplasty |
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Mallory-Weiss tears are usually at ___
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GE junction
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tx for Mallory-Weiss bleeding: first try ___, then ___, then ___.
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EGD
angio embolization surgery |
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surgery for Mallory-Weiss (2)
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high gastrotomy
suturing |
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first 2 steps in managing variceal bleeding
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ABCs
resuscitation |
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in variceal bleeding, after resuscitation give ___. this causes ___.
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octreotide
splanchnic vasconstriction |
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in variceal bleeding, after giving octreotide do ___.
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EGD
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EGD tx for variceal bleeding (2)
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band ligation
sclerotx |
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if EGD tx for variceal bleeding succeeds, ___ (5)
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continue octreotide
broad spectrum ABs repeat EGD banding nonselective beta blocker PPI |
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octreotide for variceal bleeding is for ___ days
ABs are for ___ days banding is repeated every ___ days |
3--5
7 14 |
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if EGD tx for variceal bleeding fails, do one of ___ (3)
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Sengstaken-Blakemore tamponade
TIPS surgical decompression |
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inflate ___ part of Blakemore tube first
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gastric
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