GI Emergencies

• Audio chapter
  Attending-narrated, listen on the commute.
• ABIM-format MCQs
  5-option vignettes with full wrong-answer teaching.
• Study guide
  Tables, decision trees, primary sources.
• AI tutor
  Chapter-grounded, answers the question you're stuck on.

What this chapter covers

• Section 31.1: Massive UGIB resuscitation

  Massive upper GI bleeding is a resuscitation problem before it is an endoscopic problem, and the early decisions that drive outcome happen in the first hour: airway protection, restrictive transfusion, massive transfusion protocol activation if hemorrhage is ongoing, agent-specific anticoagulation reversal, and prokinetic preparation for endoscopy.

• Section 31.2: Acute LGIB management

  Acute lower GI bleeding is hematochezia or hemodynamically significant melena from a source distal to the ligament of Treitz, and the workup branches sharply on hemodynamic stability rather than on the suspected etiology.

• Section 31.3: Acute mesenteric ischemia

  Acute mesenteric ischemia carries mortality of approximately 50 to 80 percent and has held this high mortality despite advances in imaging, because the clinical presentation is non-specific, bowel infarction occurs within hours of vascular compromise, and the diagnostic instinct is often the wrong one (the patient with severe abdominal pain and a soft abdomen looks like a non-emergent presentation until the lactate rises or the bowel infarcts).

• Section 31.4: Foreign body and food bolus impaction

  Foreign body and food bolus impaction is tested through the ASGE timing categories, which map injury risk to a removal window, plus a small set of high-yield special cases (disc batteries, sharp objects, magnets, body packers, food bolus as the EoE gateway).

• Section 31.5: Caustic ingestion and Zargar grading

  Caustic ingestion is a medical emergency in which the substance category drives the injury pattern, the airway is the first priority, the Zargar grade at endoscopy drives short-term management, and the late-stricture and squamous cell carcinoma risks drive long-term surveillance.

• Section 31.6: Esophageal perforation and Boerhaave

  Esophageal perforation can be spontaneous (Boerhaave syndrome from forceful vomiting), iatrogenic (post-endoscopic dilation, post-pneumatic dilation for achalasia, post-EGD with stricture biopsy, post-EMR or ESD), traumatic, or from caustic injury or foreign body.

• Section 31.7: Acute colonic pseudo-obstruction (Ogilvie)

  Acute colonic pseudo-obstruction (ACPO, Ogilvie syndrome) is acute massive colonic dilation without mechanical obstruction in a hospitalized patient, and the boards test it as a four-step ladder (rule out mechanical obstruction, support, neostigmine, colonoscopic decompression) anchored by a cecal-diameter and duration threshold that triggers escalation.

Podcast episodes

1. 01

   Upper Gi Bleeding

   This episode covers massive upper GI bleeding as a resuscitation problem: restrictive transfusion, massive transfusion protocol, anticoagulation reversal in the first hour, pre-endoscopic erythromycin, and the recognition traps of aortoenteric fistula and failed hemostasis.

2. 02

   Lower Gi Bleeding and Mesenteric Ischemia

   This episode covers the lower GI and ischemic emergencies: acute lower GI bleeding with its risk-stratified workup and CT angiography for active bleeding, colon ischemia recognized by pain before bleeding, and acute mesenteric ischemia where lactate out of proportion to exam and CT angiography drive the door-to-revascularization clock.

3. 03

   Foreign Body and Caustic

   This episode covers two of the mechanical and structural GI emergencies: foreign body and food bolus impaction with EGD timing driven by object type, and caustic ingestion graded by the Zargar endoscopic scale.

4. 04

   Perforation and Ogilvie

   This episode covers the last two mechanical and structural GI emergencies: esophageal perforation and Boerhaave syndrome, where imaging guides the operative-versus-stenting decision, and acute colonic pseudo-obstruction with the Ogilvie cecal-diameter threshold and neostigmine.