0071643192.pdf

TREATMENT

■ Nifedipine 10–20 mg before meals
■ Botulinum toxin injection endoscopically
■ Esophageal dilation
■ Surgery

COMPLICATIONS

Dehydration

ESOPHAGEALWEB

SYMPTOMS

Dysphagia

DIFFERENTIAL

Spasm, stricture, tumor, achalasia

DIAGNOSIS

Barium swallow or EGD

TREATMENT

Disruption of webs by endoscopy, treat iron deficiency

COMPLICATIONS

Dehydration, iron-deficiency anemia.

A 47-year-old male presents with massive hematemesis, hypotension, and

altered mental status. On exam, he has scleral icterus, a distended abdomen,

and spider telangectasias on his chest. What is the likely diagnosis?

Esophageal varices.

GI BLEEDING

Potentially life-threatening disease; incidence 100 in 100,000 for upper GI
bleeds and 20 in 100,000 for lower GI bleeds with an overall mortality rate of
about 10%; classified as upper or lower GI bleed defined by its relationship to
the ligament of Treitz

Upper GI Bleeding

ETIOLOGY

Peptic ulcer disease (most common), esophagitis, Mallory-Weiss tears, gastritis,
esophageal varices, stress ulcers, AVM, and malignancy

SYMPTOMS

■ Hematemesis or “coffee-ground” emesis
■ Hypovolemia, syncope, abdominal pain, chest pain, and dyspnea

ABDOMINAL AND GASTROINTESTINAL

EMERGENCIES

IV antibiotics can reduce the

absolute mortality associated

with an upper GI bleed in

cirrhotic patients by up to 9%.

Upper GI bleeds—

GUM BLEED

Gastritis

Ulcers

Mallory-Weiss tears

Biliary

Large esophageal varices

Esophagitis

Enteric-aortic fistula

(seen in patients with

aortic grafts)

Dieulafoy lesions (gastric

vessel aneurysm)