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What percentage of GI hemorrhages are from the upper GI tract?
What are the most common causesx of Upper GI Hem?
- Peptic ulcers
- esophageal or gastric varices
- Mallory-weis tears
What are the most common causes of Lower GI Hem?
- Diverticular disease
- ulcerative colitis
What are esophageal varices?
Dilation of the submucosal esophageal veins
What causes esophageal varices?
- portal vein thrombosis
- hepatic venous outflow obstruction
- congenital hepatic fibrosis
What is a TIPS procedure?
transjungular intrahepatic portosystemic shunt
What can you expect with a blakeman tube?
When this esoph balloon is inflated CP and SOB is normal
What is the definition of hepatic failure?
Inability of the liver to perform organ functions
What is hepatic encephalopathy?
Neurologic failure as a result of hepatic failure
What causes acute hepatic failure?
- Hepatotoxic drugs
- rey's syndrome
- Acute fatty liver of pregnancy
- Acute hepatic vein lesion
What are the causes of chronic hepatic failure?
- wilson's disease
- primary or metastatic tumor of the liver
What are the three most common causes of cirrhosis?
- 1- ETOH
- 2- Obesity
- 3- Hepatitis
What is cirrhosis?
Liver parenchymal cells are progressively destroyed and replaced with fibrotic tissue.
How much of the liver can be destroyed before cirrhosis symptoms appear?
What is acute pancreatitis?
Acute inflamation of the pancreas
What are the causes of acute pancreatitis?
- obstruction of the common bile duct
- Peptic ulcer with perf
- Surgical trauma
- Ovarian cyst
- Ischemia, Post CPB
- 20% are idopathic
What is Grey Turner's sign?
Ecchymosis on flank
What percentage of patients with acute pancreatitis die?
What is an intestional infarction?
Necrosis of intestinal wall resulting from ischemia
What are causes of intestional infarction?
- mural thrombus
- emboli (AF)
- surgical procedures
- strangulated intestinal obstruction
- intra-abdominal infection
How is an intestional infarction treated?
- Intervention or OR
- D/C Vasopressors with bowel ischemia
- Prevent perf with NGT, elevate HOB
What is needed to diagnose C. Difficile?
Greater than 3 day history of watery, foul smelling stool;, with history of antibiotic therapy and colitis (Abd pain)
What is cullen's sign?
Ecchymosis around unbilicus in hemorrhagic pancreatitis
What is Ker's sign?
Splenic rupture- left shoulder pain due to diaphragmatic irritation
How should GI assessment be done?
Inspection, ausculation, palpation, labs
What does retention of phosphorus cause?
A reciprocal drop in serum calcium