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