5: Upper GI Bleed

Question 1

Location cutoff for Upper vs lower GIB

Answer 1

Upper: proximal to ligament of Treitz

Question 2

Most common cause of acute UGIB

Answer 2

PUD

Question 3

Hematochezia

Answer 3

Bright red blood per rectum

Question 4

Three major signs of hypovolemia

Answer 4

1. Resting tachy
2. Orthostatic hypotension
3. Supine hypotension

Question 5

What does the BUN/creatinine ratio do in UGIB?

Answer 5

BUN increases -> BUN/cream ratio increases to 30:1 ish

Question 6

How much should Hb rise for every unit of transfused RBCs

Answer 6

1 g / dL

Question 7

Other name for stress ulcers

Answer 7

Stress related mucosal disease (SRMD)

Question 8

Two types of stress ulcers and explain

Answer 8

1. Curling’s ulcers: peptic ulcer in pt with extensive burns

2. Cushing’s ulcers: peptic ulcer from severe brain injury or with other CNS lesions

Question 9

Four factors that increase bleeding risk in pts with esophageal varices

Answer 9

1. Size of varices larger than 5mm
2. Red wale markings at endoscopy (dilated venules)
3. Severity of liver disease
4. Active alcohol abuse

Question 10

Four things to draw labs on in pts with Zollinger-Ellison to excluded MEN1 disease

Answer 10

1. Serum PTH
2. Prolactin
3. LH-FSH
4. GH

Question 11

Subcutaneous emphysema

Answer 11

Air in tissues, typically detected in neck or precordial area

Question 12

Hamman’s sign

Answer 12

Crunching, rasping sound synchronous with heartbeat heard over precordium dueling systole