GI Tract and Upper GI Bleed Tutoring By Alaina Darby

The GI Tract

RB is a 72 yo WF who is taking ASA, oxycodone, alendronate, furosemide, KCl, and Premarin. Which of her medications is least likely to cause GI mucosal injury? ASA Oxycodone Alendronate KCl b

RB is a 72 yo WF who is taking ASA, oxycodone, alendronate, furosemide, KCl, and Premarin. Which of her medications is most likely to cause jaundice? ASA Oxycodone Furosemide Premarin d

RB is a 72 yo WF who is taking ASA, oxycodone, alendronate, furosemide, KCl, and Premarin. Which of her medications is most likely to cause pancreatitis? ASA Alendronate Furosemide Premarin c

Pancreatitis? Think about… Didanosine Tetracyclines Azathioprine Aspirin/ACEi Valproate Bactrim Ethanol Lasix Steroids Ethacrynic acid Thiazides Sulfas/Salicylates Pancreatitis? Think about…

TL is a 44 yo WM who has been having RUQ pain that started 5 hours ago TL is a 44 yo WM who has been having RUQ pain that started 5 hours ago. Which of the following would likely be elevated in this patient? AlkPhos ALT AST Bilirubin c

TL is a 44 yo WM who has been having RUQ pain that started 5 hours ago TL is a 44 yo WM who has been having RUQ pain that started 5 hours ago. Which of the following would you want to monitor over the next 48 hours? AlkPhos ALT AST Bilirubin b

JD has an elevated total bilirubin JD has an elevated total bilirubin. Which of the following medications would likely be the culprit? APAP Ethanol Isoniazid Phenytoin b

Due to decreased conjugation in the liver JD has an elevated total bilirubin. Should it be due to an elevation of indirect bilirubin, which of the following would be true? Due to decreased conjugation in the liver Due to increased conjugation in the liver Due to red blood cell breakdown Due to decreased unconjugated bilirubin c

Elevated INR, elevated LFTs Decreased INR, elevated LFTs Which of the following would likely be seen with liver dysfunction that is not associated with bile duct occlusion? Elevated INR, elevated LFTs Decreased INR, elevated LFTs Elevated GGTs, elevated LFTs Decreased GGTs, elevated LFTs a

Which of the following is most indicative of pancreatitis? Amylase Ammonia GGT Lipase d

Elevation of which of the following may lead to encephalopathy? Amylase Ammonia GGT Lipase d

Fecal occult blood test Fecal leukocyte test JD is a 60 yo AAM with anemia due to CKD and PMH of MI. If he is taking the appropriate medications for these conditions, which of the following tests may be falsely positive or elevated in him? Amylase/lipase Coagulation test Fecal occult blood test Fecal leukocyte test c

Barium enema with colonoscopy Barium swallow with EGD Which of the following would most likely be used to evaluate a patient with tarry stools? Barium enema with colonoscopy Barium swallow with EGD Barium enema with EGD Barium swallow with colonoscopy a

Abdominal CT with contrast Abdominal MRI RB is a 42 yo AAM who is 125 kg and has prison tattoos. He takes Metformin for diabetes. He is having abdominal pain and needs visualization. Which test would you suggest to best visualize his GIT? Abdominal ultrasound Abdominal CT Abdominal CT with contrast Abdominal MRI b

Abdominal CT with contrast Abdominal MRI RB is a 42 yo AAF who is 73 kg and has kidney failure. She is having abdominal pain and needs visualization. Which test would you suggest to best visualize her GIT? Abdominal ultrasound Abdominal CT Abdominal CT with contrast Abdominal MRI d

Refrigerate the solution Which of the following should not be recommended to a patient who is undergoing a colonoscopy? Refrigerate the solution Flavor it the solution with blue or green koolaid Eat plenty of fiber Split the dose of the solution c

88 yo WF with no comorbidities 24 yo WM with h/o MI 22 yo WM with CKD Which of the following patients would not be a good candidate for hyperosmotic solutions as opposed to GI lavage solutions? 41 yo WF with CHF 88 yo WF with no comorbidities 24 yo WM with h/o MI 22 yo WM with CKD d

Upper GI Bleed

JR takes ibuprofen and Tums OTC JR takes ibuprofen and Tums OTC. He has noticed that his sputum is a rusty color and asks you what he should do. What is the likely cause of his symptoms? Varices Ulcers Malignancy Erosive esophagitis b

PUD from a single vessel PUD from multiple vessels JR takes ibuprofen and Tums OTC. He has noticed that his sputum is a rusty color and asks you what he should do. How would you describe his likely condition? PUD from a single vessel PUD from multiple vessels SRMD from a single vessels SRMD from multiple vessels a

JD is a 68 yo WM with a PMH of diabetes and prior MI JD is a 68 yo WM with a PMH of diabetes and prior MI. He accidentally took his medication twice this morning. He presents with bloody emesis. Which of the following should you do first? NG tube lavage to get rid of the excess medication IV access to begin administering NS IV access to begin administering PRBCs Administration of promotility agents to clean out the GIT Labs: WBC: 13.5 (H) Hgb: 10.5 (L) Hct: 33 (L) SCr: 2 (H) Vitals: BP: 80/62 HR: 112 RR: 22 b

JD is a 68 yo WM with a PMH of diabetes and prior MI JD is a 68 yo WM with a PMH of diabetes and prior MI. He accidentally took his medication twice this morning. He presents with bloody emesis. At what Hgb level would blood products be indicated? 5 7 9 11 Labs: WBC: 13.5 (H) Hgb: 10.5 (L) Hct: 33 (L) SCr: 2 (H) Vitals: BP: 80/62 HR: 112 RR: 22 b Blood products have risks! Immunologic, infection, etc.

JD is a 68 yo WM with a PMH of diabetes and prior MI JD is a 68 yo WM with a PMH of diabetes and prior MI. He accidentally took his medication twice this morning. He presents with bloody emesis. If his Hgb did dip to 7, what would be the typical blood product to administer? PRBCs FFP Platelets A combination of the above Labs: WBC: 13.5 (H) Hgb: 10.5 (L) Hct: 33 (L) SCr: 2 (H) Vitals: BP: 80/62 HR: 112 RR: 22 d

JD is a 68 yo WM with a PMH of diabetes and prior MI JD is a 68 yo WM with a PMH of diabetes and prior MI. He accidentally took his medication twice this morning. He presents with bloody emesis. Would endoscopy be indicated in this patient and why? Yes, he likely has active bleeding Yes, he is hemodynamically unstable No, he likely has active bleeding No, he is hemodynamically unstable Labs: WBC: 13.5 (H) Hgb: 10.5 (L) Hct: 33 (L) SCr: 2 (H) Vitals: BP: 80/62 HR: 112 RR: 22 a… He does need to be HD stabilized first, though!

JD is a 68 yo WM with a PMH of diabetes and prior MI JD is a 68 yo WM with a PMH of diabetes and prior MI. He accidentally took his medication twice this morning. He presents with bloody emesis. How would you want to manage this patient? Stabilize then early endoscopy with fibrin sealant Stabilize then early endoscopy with injection of epinephrine Stabilize then early endoscopy with thermal coagulation Stabilize then early endoscopy without endoscopic therapy Labs: WBC: 13.5 (H) Hgb: 10.5 (L) Hct: 33 (L) SCr: 2 (H) Vitals: BP: 80/62 HR: 112 RR: 22 c

JD is a 68 yo WM with a PMH of diabetes and prior MI JD is a 68 yo WM with a PMH of diabetes and prior MI. He accidentally took his medication twice this morning. He presents with bloody emesis. How would you want to manage this patient? IV bolus of ranitidine 150 mg initial with 15 mg/hr continuous infusion afterward IV bolus of famotidine 150 mg initial with 15 mg/hr continuous infusion afterward IV bolus of pantoprazole 60 mg initial with 6 mg/hr continuous infusion afterward IV bolus of lansoprazole 60 mg initial with 6 mg/hr continuous infusion afterward Labs: WBC: 13.5 (H) Hgb: 10.5 (L) Hct: 33 (L) SCr: 2 (H) Vitals: BP: 80/62 HR: 112 RR: 22 d

JD is a 68 yo WM with a PMH of diabetes and prior MI JD is a 68 yo WM with a PMH of diabetes and prior MI. He accidentally took his medication twice this morning. He presents with bloody emesis. How long should therapy continue? 1 day 3 days 5 days 7 days Labs: WBC: 13.5 (H) Hgb: 10.5 (L) Hct: 33 (L) SCr: 2 (H) Vitals: BP: 80/62 HR: 112 RR: 22 b

JD is a 68 yo WM with a PMH of diabetes and prior MI JD is a 68 yo WM with a PMH of diabetes and prior MI. He accidentally took his medication twice this morning. He presents with bloody emesis. Which of the following would potentially be an alternate option? PO pantoprazole 60 mg Q day with 72 hours of hospitalization PO pantoprazole 80 mg Q day with 72 hours of hospitalization PO pantoprazole 60 mg Q day with outpatient treatment PO pantoprazole 80 mg Q day with outpatient treatment Labs: WBC: 13.5 (H) Hgb: 10.5 (L) Hct: 33 (L) SCr: 2 (H) Vitals: BP: 80/62 HR: 112 RR: 22 b

JD is a 68 yo WM with a PMH of diabetes and prior MI JD is a 68 yo WM with a PMH of diabetes and prior MI. He accidentally took his medication twice this morning. He presents with bloody emesis. Which of the following would be the preferred regimen upon discharge? Esomeprazole + celecoxib Esomeprazole + ASA Esomeprazole + clopidogrel Celecoxib alone Labs: WBC: 13.5 (H) Hgb: 10.5 (L) Hct: 33 (L) SCr: 2 (H) Vitals: BP: 80/62 HR: 112 RR: 22 c

FR is a 34 yo WM with a history of alcoholism FR is a 34 yo WM with a history of alcoholism. He presents to you with fatigue and dizziness. Which of the following would you most likely use for resuscitation? PRBCs NS D5W Albumin Labs: WBC: 10 Hgb: 10.5 Hct: 33 Platelets: 45,000 SCr: 1 Vitals: BP: 92/64 HR: 120 RR: 23 a

Crystalloid Colloid Blood products NS Albumin Whole blood LR Dextran PRBCs D5W Starches FFP Mannitol Platelets

FR is a 34 yo WM with a history of alcoholism FR is a 34 yo WM with a history of alcoholism. He presents to you with fatigue and dizziness. Which of the following would not be indicated in this patient? Platelet transfusion Antibiotics Octreotide Isosorbide mononitrate Labs: WBC: 10 Hgb: 10.5 Hct: 33 Platelets: 45,000 SCr: 1 Vitals: BP: 92/64 HR: 120 RR: 23 d

Patients who are at risk for variceal bleeding should definitively receive which of the following? Propranolol Metoclopramide Losartan Clonidine a