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23 Cards in this Set
- Front
- Back
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what causes upper GI bleed |
nonspecific mucosal abnl peptic ulcer = MC esophageal inflm/varices mallory-weiss tears angiodysplasia tumors |
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what is important in the hx of a pt with UGI bleed |
prior hx (bleed from same spot) liver disease, alcohol abuse: varices retching, coughing: mallory-weiss tear prior H. pylori infx, NSAIDs: PUD malignancy meds: ASA, anticoagulants, bisphosphonate |
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what do you find on PE with UGI bleed? |
hypovolemia tachycarida blood loss rectal exam: color, guaiac |
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what labs are affected with UGI bleed |
CBC- blood count can be nl in acute increased BUN to Cr ratio = >20-100:1 PT/PTT, chem 8, LFT, CK (MI) |
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dx of UGI bleed |
endoscopy tagged RBC scan angiography esophageal capsule
NO barium- interfere with endoscopy or surgery |
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what causes esophageal varices |
-portal hypertension- MC: viral, alcoholic liver disease, nonalcoholic steatoheptitis (NASH) -pancreatitis or carcinoma -LUQ tramua |
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RF for varices |
child class B or C cirrhosis |
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who to tx varices |
ICU: O2 and EKG NPO 2 lg bore IVs: bolus crystalloid, blood products PPI |
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tx for acute bleed with varices (not meds) |
stabilize hemodynamic (avoid over transfusion) endoscopic band ligation TIP short term: balloon tamponade long term: liver transplant |
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what drugs do we use for acute bleed with varices |
-PPI -abx -octreotideL inhibit vasoactive compound like glucagon and decrease portal flow -vasopressin: decrease medenteric arterial flow -vit K: hasnt been shown to work
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sx of peptic ulcer |
dyspepsia burning or hunger pain classic duodenal ulcer: pain 2-5h pc, relief with food visceral sensation nonspeicific silent ulcers |
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what drugs can induce peptic ulcer |
NSAIDs, theophylline, smoking, alcohol, caffeine |
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how do you test for H. pylori |
always get at least 2 tests to double check relapse common |
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medications for peptic ulcer |
H2blockers and PPI anatacids and sucralfate better than placebo in healing duodenal ulcers, not in gastric ulcers |
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tx for peptic ulcer (not meds) |
remove NSAIDS, smoking, excessive alcohol stress mamagement avoid certain foods |
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what happens with prolonged use of PPI |
most potent gastric acid inhibitor C. diff, impaired Ca/iron/B12/Mg absorption pneumonia, osteoporosis in smokers |
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what is mallory-weiss syndrome |
longitudinal mucosal laceration in distal esophagus and proximal stomach from forceful retching causing submucosal and bleed |
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precipitating factors of mallory-weiss syndrome |
vomit straining at stool or lifting seizure trauma colonoscopy prep |
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predisoposing conditions of mallory weiss |
hiatus hernia heavy alcohol abuse leading to vomiting |
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sx of mallory weiss |
acute GI bleed usually single tear |
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tx for mallory weiss |
-blood transfusion -endoscopic therapy: inject epinephrine, ethanol, other sclerosants -banding -electrocoagulation: MC thermal therapy, contraindicated in portal HTN |
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what is Boerhaave syndrome |
spontaneous perforation of esophagus |
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RF of boerhaave syndrome |
caustic ingestion pill esophgitis barretts esophagus infx esophageal dilation
rare but fatal |
