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29 Cards in this Set
- Front
- Back
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1. First step in tx of pt w/Upper GI haemorrhage?
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a. IV fluid resuscitation
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2. Best initial tx of upper GI bleeding?
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a. Prompt attention to the pt’s ABCs is mandatory for pts w/acute upper GI haemorrhage.
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3. Steps in evaluation of upper GI tract haemorrhage?
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a. Determine if bleeding is acute or occult.
b. A critical part of the initial evaluation is assessment of the pt’s physiologic status to gauge the severity of blood loss. |
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4. Sequence of management of acute GI tract haemorrhage?
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1. Resuscitation
2. Diagnosis 3. Treatment |
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5. Signs of acute bleeding?
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a. Hx of Hematemesis
b. Coffee-ground emesis c. Melena d. Bleeding per rectum |
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6. Signs of occult bleeding?
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a. S/S of anaemia and no clear hx of blood loss.
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7. Parameters to monitor with GI haemorrhage?
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1. Urine output
2. clinical appearance 3. BP 4. HR 5. Serial H/H. 6. Consideration of central venous pressure (CVP) monitoring. |
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8. What is recommended prior to endoscopy for pts w/massive upper GI bleeding, agitation, or impaired respiratory status?
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a. Endotracheal intubation!
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9. What should be ordered for pt w/massive bleeding?
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a. CBC
b. LFTs c. PT d. PTT e. A type and cross-match should be ordered |
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10. What should be administered if thrombocytopenia or coagulopathy is identified?
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a. Platelets and FFP respectively.
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11. Mallory-Weiss tear?
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a. A proximal gastric mucosa tear following vigorous coughing retching, or vomiting.
b. The bleeding is generally self-limited, mild, and amenable to supportive care and endoscopic management. |
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12. Dieulafoy Erosion?
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a. Infrequently encountered.
b. Describes bleeding from an aberrant submucosal artery located in the stomach. c. This bleeding is frequently significant and requires prompt diagnosis by endoscopy, followed by endoscopic or operative therapy. |
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13. GI AVM (Arteriovenous malformation)?
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a. A small mucosal lesion located along the GI tract.
b. Bleeding is usually abrupt, but the rate of bleeding I usually slow and self-limiting. |
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14. Oesophagitis?
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a. Mucosal erosion frequently resulting from Gastroesophageal reflux, infections, or medications.
b. Pts most frequently present w/occult bleeding, and treatment consists of correction or avoidance of the underlying causes. |
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15. Shock: Stage 1- How much blood lost and compensated or not?
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a. <750 mL of blood loss
b. Well compensated. |
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16. Shock: Stage 2- How much blood lost and vitals?
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a. 750-1500 ml blood loss.
b. Slight tachycardia c. Normal BP |
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17. Shock: Stage 3- How much blood lost and vitals?
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a. 1500-2000 ml
b. Moderate tachycardia c. Hypotension |
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18. Shock: Stage 4- How much blood lost and vitals?
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a. >2000 mL blood loss
b. Marked tachycardia c. Prominent hypotension. |
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19. What designates upper GI blood loss?
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a. Proximal to ligament of Treitz.
b. Accounts for 80% of all significant GI bleeding. |
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20. What percent of upper GI bleeding is self-limited?
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a. 80%.
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21. Overall mortality associated w/Upper GI bleeding?
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a. 8-10%.
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22. What factors increase pt mortality w/acute upper GI bleeding?
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a. Rebleeding
b. Increased age c. Pts who develop bleeding in the hospital. |
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23. What % of pts taking NSAIDs develop an acute ulcer?
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a. ~10%.
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24. When is surgery indicated for upper GI bleeding?
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a. For complicated peptic ulcer disease with massive, persistent, or recurrent upper GI tract haemorrhage
b. Or c. In association w/non-healing or giant ulcers (>3cm) |
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25. Tx of bleeding gastric ulcer where there is a concern for possible malignancy?
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a. Gastrectomy
b. Or c. Excision of the ulcer. |
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26. Surgical tx of other types of ulcers (those which can’t be treated by EGD or med)?
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a. May require vessel ligation followed by a vagotomy procedure and pyloroplasty.
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27. Tx of pts if bleeding source cannot be identified but active bleeding is clearly occurring?
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a. Selective angiography
b. This can dx and tx bleeding in roughly 70% of pts. c. Arterial embolization with gel foam, metal coil springs, or a clot can be used to control bleeding. d. In addition, arterial vasopressin can stop bleeding in some pts w/peptic ulcer disease. |
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28. Most common sx w/Gastric cancer?
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a. Wt. loss and anorexia.
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29. Most common cause of paediatric significant upper GI bleeding?
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a. Variceal bleeding from extrahepatic portal venous obstruction.
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