06 S P M P On Acute Gastrointestinal Bleeding
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![SPMP on Acute Gastrointestinal Bleeding Dr. S. Aswini Kumar. MD A 45 year-old man is admitted with sudden onset of vomiting of blood in large quantities: VI. 01. The diagnosis or upper gastrointestinal bleeding can be suspected in presence of the following EXCEPT: Blood vomited is red in color Coffee ground vomitus Presence of accompanying food particles History of cough with expectoration Presence of black tarry stools VI. 02. Hemoptysis is more likely possibility in presence of all of the following symptoms EXCEPT: Coughing which precedes Sputum accompanying the spitting of blood Previous history of lung disease CXR demonstrating pulmonary lesion All of the above VI. 03. Common cause for upper gastrointestinal bleeding in the adult is: Peptic ulcer disease Esophageal varices Acute erosive gastritis Mallory Weiss tears All of the above VI. 04. Uncommon causes of UGI bleeding in an adult are the following EXCEPT: Esophagitis Stress ulcer Esophageal or gastric neoplasm Appendicitis Vascular Ectasia VI. 05. Amount of blood lost from the stomach can be inferred from: Quantity of blood lost as narrated by patient Amount of blood drained by Ryle’s tube Blood pressure fall in sequential recordings The progressive increase in pallor All of the above VI. 06. The following statements about nasogastric aspiration are TRUE, EXCEPT: A NGT should be inserted in all patients The NGT should be manually aspirated Continuous suction is contraindicated Presence of blood or coffee ground s is diagnostic A heme occult test should be performed on it VI. 07. Investigations to be done as an emergency are the following EXCEPT: Estimation of Hb and CBC PT APTT and platelet count Blood grouping and cross matching Liver function tests in all patients X-Ray films of chest and abdomen VI. 08. Following treatment should be instituted immediately EXCEPT: Insertion of large bore IV fluid access. Administer large volumes of normal saline Naso-gastric lavage with ice cold normal saline. Emergency transfusion of fresh whole blood, Inj. Heparin 5000units S/C 8hrly VI. 09. All of the following are indications for urgent Blood Transfusion EXCEPT: Naso-gastric aspiration showing active bleeding Patient is in shock or BP is below 90mmHg Hemoglobin is less than 5 gm% Total amount of blood lost is less than 200ml Black tarry stools are present VI. 10. All the following statements regarding Octreotide are TRUE EXCEPT: ,[object Object]](https://image.slidesharecdn.com/06spmponacutegastrointestinalbleeding-090820020923-phpapp02/85/06-s-p-m-p-on-acute-gastrointestinal-bleeding-1-320.jpg)
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06 S P M P On Acute Gastrointestinal Bleeding
- 2. Initial dose of 50 micro gram /hour IV is given
- 3. Maintenance dose is 25ug/hour as IV infusion.
- 4. No major contra indications except hypersensitivity.
- 6. Initiated as a stop gap measure until endoscopy
- 7. Dose of 100 units in 250ml of 5% dextrose IV.
- 8. Can cause coronary, mesenteric or cerebral ischemia
- 10. Nil orally till bleeding stops
- 11. Liquid diet with milk or kanji water, thereafter
- 12. Prohibition of tea, coffee, alcohol and smoking
- 14. Inj. Ampicillin 1gm IV q6hrly
- 15. Bowel wash BID
- 16. High protein low carbohydrate diet by mouth
- 17. Propranolol 20-40 mg thrice daily VI. 17. Indications for emergency surgical consultation are the following EXCEPT: Associated perforation, obstruction or malignancy Bleeding after recent GI surgery Good response to endoscopic therapy Endoscopic stigmata of high risk of re-bleeding Suspected aorto=enteric fistula or vasculopathy