Welcome to Tangents, the Toronto Western Hospital morning report blog.
This was the idea of Isaac Bogoch, one of last year's CMRs, and I'd like to continue his great work this year.
The goal is to briefly summarize the topics discussed and give you links to some more detailed resources if you're interested.
Please feel free to give me any feedback on how to make it more useful to you.
David
This was the idea of Isaac Bogoch, one of last year's CMRs, and I'd like to continue his great work this year.
The goal is to briefly summarize the topics discussed and give you links to some more detailed resources if you're interested.
Please feel free to give me any feedback on how to make it more useful to you.
David
UGIB
On Tuesday, we discussed issues related to upper GI bleeds.
Gastric ulcer with ASA tab in it!
Issues that came up:
DDx
-Ulcer (NSAIDS, H pylori) DU in 2nd/3rd part of duodenum suggests Zollinger-Ellison. Gastric ulcer: think of gastric cancer
-Varices (EtOH, hepatitis). High pressure venous system = big bleed
-Mallory-Weiss tears: vomiting hx. This is partial, vs. Boerhaave: rupture
-Esophagitis/gastritis (reflux, NSAID)
-Portal HTN gastropathy (like varices in stomach)
-Others: Dieulafoy's lesion, epistaxis, many others.
Checklist approach to acute UGIB management
1) Large bore IV access- at least 2
2) Group and screen, be ready to transfuse
3) Reverse any coagulopathy
4) PPI- IV or PO
5) Octreotide if known varices or high probability of variceal etiology
6) GI consult, possible urgent endoscopy
H. Pylori:
Acquisition: usually from childhood due to contaminated drinking water. Spread can occur person to person, especially within households.
Diagnostic tests:
Serology: Sensitive, but does not differentiate active vs. past infection
Urea breath test: Differentiates active vs. previous infection
Biopsy: Gold standard
Ferritin in Fe deficiency:
From Guyatt et al:
Likelihood ratios of Fe def (compared to gold standard of bone marrow bx):
Ferritin: LR
>100: 0.13
45-100: 0.46
18-45: 3.12
<18: 41.47
Cutoff of 41 is 98% Sn and 98% Sp
Some useful references- may need U of T computer to access full text.
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