Factoids
Anatomy
Intra-op Decision Making
Peri-operative Considerations
Eponyms
100
For a patient who continues to bleed after a 2nd attempt at endoscopic control of a bleeding ulcer, this is the next most appropriate intervention
Angiographic embolization
100
Name the 3 branches of the celiac axis
Splenic artery, left gastric artery, common hepatic artery
100
When operating for a bleeding ulcer, vagotomy should be considered in which group of patients?
Patients who have failed, or are unable to comply with, PPI therapy
100
This medication prophylactically reduces the risk of variceal bleeding
Propranolol
100
This UGIB source is classically characterized by emesis that turns from non-bloody to bloody
Mallory-Weiss tear
200
This underlying process is the #1 cause of aorto-enteric fistula formation
Aortic graft infection
200
Isolated gastric varices are pathognomic for
Splenic vein thrombosis
200
This is the next step in acute management if rubber bandings and intravariceal sclerosing therapy do not control esophageal variceal hemorrhage
Balloon tamponade
(Sengstaken–Blakemore tube)
200
This is the recommended period of post-endoscopy NPO status following endoscopic control of a bleeding duodenal ulcer with low risk features
0 hours
200
Describe a Cushing ulcer
Gastric ulcer associated with elevated ICP
300
Name the classic triad of hemobilia
- obstructive jaundice
- RUQ pain
- UGIB
300
This vessel is the source of the gastroduodenal artery
Common hepatic artery
300
This is the recommended vascular reconstruction option for patients with an aortoenteric fistula
Axillary bifemoral bypass
300
This is the most sensitive imaging test to detect upper GI bleeding
Tagged RBC scan
300
In persons with a hiatal hernia, these are linear mucosal ulcerations of the stomach occurring where the stomach is constricted by the diaphragmatic hiatus
Cameron lesions
400
On initial EGD for diagnosis and management of a bleeding duodenal ulcer, name the location which should be biopsied and the reasoning for this biopsy
Biopsy gastric mucosa to evaluate for H. pylori
400
This is where Type II Gastric ulcers are located
Lesser curvature and duodenal bulb
400
When performing a truncal vagotomy, this procedure must also be performed to prevent post-operative complication
pyloroplasty
E.g. Heineke-Mikulicz pyloroplasty
400
Name the 3 hard indications for operative intervention in a bleeding ulcer
- hemodynamic instability
- transfusion >6 units
- EGD fails to control hemorrhage
400
This is a large submucosal arteriole in the stomach which is prone to bleeding
Dieulafoy lesion
500
List the findings of an ulcer on EGD which predict the risk of rebleeding, from highest to lowest risk
(HINT: there are five)
1. active pulsatile bleeding
2. active oozing
3. visible vessel
4. adherent clot
5. flat pigmented spot
Example of #3:
500
When ligating a bleeding GDA, three sutures are placed: superior, inferior, and medial. The medial stitch is intended to ligate this named structure
Transverse pancreatic artery
500
This is the surgical treatment for a persistently bleeding Type I gastric ulcer
Wedge resection
500
The AIMS65 score predicts mortality in patients with acute UGIB. Name the 5 variables which encompass the AIMS65 score
1. Albumin
2. INR
3. Mental status
4. Systolic BP < 90
5. Age > 65
500
Describe a Curling ulcer
Gastric ulcer resulting as a complication of severe burns