Transcript 3-11-17 PPT

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?
a.
ASA
b. Oxycodone
c.
Alendronate
d. KCl
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?
a.
ASA
b. Oxycodone
c.
Furosemide
d. Premarin
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?
a.
ASA
b. Alendronate
c.
Furosemide
d. Premarin
Pancreatitis? Think about…
Didanosine
Azathioprine
Valproate
Ethanol
Steroids
Tetracyclines
Aspirin/ACEi
Bactrim
Lasix
Ethacrynic acid
Thiazides
Sulfas/Salicylates
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?
a.
AlkPhos
b. ALT
c.
AST
d. Bilirubin
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?
a.
AlkPhos
b. ALT
c.
AST
d. Bilirubin
JD has an elevated total bilirubin. Which of the following
medications would likely be the culprit?
a.
APAP
b. Ethanol
c.
Isoniazid
d. Phenytoin
JD has an elevated total bilirubin. Should it be due to an elevation of
indirect bilirubin, which of the following would be true?
a.
Due to decreased conjugation in the liver
b. Due to increased conjugation in the liver
c.
Due to red blood cell breakdown
d. Due to decreased unconjugated bilirubin
Which of the following would likely be seen with liver dysfunction
that is not associated with bile duct occlusion?
a.
Elevated INR, elevated LFTs
b. Decreased INR, elevated LFTs
c.
Elevated GGTs, elevated LFTs
d. Decreased GGTs, elevated LFTs
Which of the following is most indicative of pancreatitis?
a.
Amylase
b. Ammonia
c.
GGT
d. Lipase
Elevation of which of the following may lead to encephalopathy?
a.
Amylase
b. Ammonia
c.
GGT
d. Lipase
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?
a.
Amylase/lipase
b. Coagulation test
c.
Fecal occult blood test
d. Fecal leukocyte test
Which of the following would most likely be used to evaluate a
patient with tarry stools?
a.
Barium enema with colonoscopy
b. Barium swallow with EGD
c.
Barium enema with EGD
d. Barium swallow with colonoscopy
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?
a.
Abdominal ultrasound
b. Abdominal CT
c.
Abdominal CT with contrast
d. 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?
a.
Abdominal ultrasound
b. Abdominal CT
c.
Abdominal CT with contrast
d. Abdominal MRI
Which of the following should not be recommended to a patient
who is undergoing a colonoscopy?
a.
Refrigerate the solution
b. Flavor it the solution with blue or green koolaid
c.
Eat plenty of fiber
d. Split the dose of the solution
Which of the following patients would not be a good candidate for
hyperosmotic solutions as opposed to GI lavage solutions?
a.
41 yo WF with CHF
b. 88 yo WF with no comorbidities
c.
24 yo WM with h/o MI
d. 22 yo WM with CKD
Upper GI Bleed
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?
a.
Varices
b. Ulcers
c.
Malignancy
d. Erosive esophagitis
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?
a.
PUD from a single vessel
b. PUD from multiple vessels
c.
SRMD from a single vessels
d. SRMD from multiple vessels
Labs:
WBC: 13.5 (H)
Hgb: 10.5 (L)
Hct: 33 (L)
SCr: 2 (H)
Vitals:
BP: 80/62
HR: 112
RR: 22
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?
a.
NG tube lavage to get rid of the excess medication
b. IV access to begin administering NS
c.
IV access to begin administering PRBCs
d. Administration of promotility agents to clean out the GIT
Labs:
WBC: 13.5 (H)
Hgb: 10.5 (L)
Hct: 33 (L)
SCr: 2 (H)
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?
a.
Vitals:
BP: 80/62
HR: 112
RR: 22
5
b. 7
c.
9
d. 11
Labs:
WBC: 13.5 (H)
Hgb: 10.5 (L)
Hct: 33 (L)
SCr: 2 (H)
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?
a.
Vitals:
BP: 80/62
HR: 112
RR: 22
PRBCs
b. FFP
c.
Platelets
d. A combination of the above
Labs:
WBC: 13.5 (H)
Hgb: 10.5 (L)
Hct: 33 (L)
SCr: 2 (H)
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?
a.
Vitals:
BP: 80/62
HR: 112
RR: 22
Yes, he likely has active bleeding
b. Yes, he is hemodynamically unstable
c.
No, he likely has active bleeding
d. 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
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?
a.
Stabilize then early endoscopy with fibrin sealant
b. Stabilize then early endoscopy with injection of epinephrine
c.
Stabilize then early endoscopy with thermal coagulation
d. 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
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?
a.
IV bolus of ranitidine 150 mg initial with 15 mg/hr continuous
infusion afterward
b. IV bolus of famotidine 150 mg initial with 15 mg/hr continuous
infusion afterward
c.
IV bolus of pantoprazole 60 mg initial with 6 mg/hr continuous
infusion afterward
d. 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
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?
a.
1 day
b. 3 days
c.
5 days
d. 7 days
Labs:
WBC: 13.5 (H)
Hgb: 10.5 (L)
Hct: 33 (L)
SCr: 2 (H)
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?
a.
Vitals:
BP: 80/62
HR: 112
RR: 22
PO pantoprazole 60 mg Q day with 72 hours of hospitalization
b. PO pantoprazole 80 mg Q day with 72 hours of hospitalization
c.
PO pantoprazole 60 mg Q day with outpatient treatment
d. PO pantoprazole 80 mg Q day with outpatient treatment
Labs:
WBC: 13.5 (H)
Hgb: 10.5 (L)
Hct: 33 (L)
SCr: 2 (H)
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?
a.
Vitals:
BP: 80/62
HR: 112
RR: 22
Esomeprazole + celecoxib
b. Esomeprazole + ASA
c.
Esomeprazole + clopidogrel
d. Celecoxib alone
Labs:
WBC: 10
Hgb: 10.5
Hct: 33
Platelets: 45,000
SCr: 1
Vitals:
BP: 92/64
HR: 120
RR: 23
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?
a.
PRBCs
b. NS
c.
D5W
d. Albumin
Crystalloid
Colloid
Blood products
NS
Albumin
Whole blood
LR
Dextran
PRBCs
D5W
Starches
FFP
Mannitol
Platelets
Labs:
WBC: 10
Hgb: 10.5
Hct: 33
Platelets: 45,000
SCr: 1
Vitals:
BP: 92/64
HR: 120
RR: 23
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?
a.
Platelet transfusion
b. Antibiotics
c.
Octreotide
d. Isosorbide mononitrate
Patients who are at risk for variceal bleeding should definitively
receive which of the following?
a.
Propranolol
b. Metoclopramide
c.
Losartan
d. Clonidine