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Gastroenterology and Hepatology Board Review by John K. DiBaise

By John K. DiBaise

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True/False: A clean ulcer base has a very low incidence of rebleeding and requires no endoscopic therapy. True. The incidence of rebleeding is less than 5%. ❍ What are some clinical predictors of ulcer rebleeding? Shock (hemodynamic instability), anemia, hematemesis, and persistent bloody lavage. ❍ What information can be obtained from a bloody nasogastric aspirate associated with hematochezia? The patient is bleeding rapidly from the stomach or duodenum and has an increased risk of morbidity and mortality.

What is it? How is it treated? Figure 1-16 See also color plate. Cecal angiodysplasia, commonly called arteriovenous malformation (AVM). Several endoscopic, angiographic, and surgical methods are available to obliterate these lesions. Noncontact treatments such as argon plasma coagulation seem to be the most popular method currently. ❍ True/False: Angiodysplasia can present as occult intestinal bleeding. True. ❍ Where in the colon is the most common site of diverticular hemorrhage? The left side of the colon.

Colonoscopy is performed. What is the most likely diagnosis? Figure 1-6 See also color plate. Diverticular bleeding from the colon. ❍ What is the most common complication of upper gastrointestinal endoscopy in a patient with active upper gastrointestinal hemorrhage? Aspiration pneumonia. ❍ In an acutely bleeding patient, what is the first step in management? Support the intravascular volume (ie, fluid resuscitation). Once hemodynamically stable, further evaluation can safely be performed. ❍ In a patient who is vigorously bleeding from esophageal varices despite pharmacotherapy and banding of varices and who is waiting for a surgical suite to become available for portosystemic shunt, what therapeutic maneuver is available that may control the hemorrhage?

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