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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