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Stomach· Chapter 09

Upper GI Bleeding

Glasgow-Blatchford and AIMS65 risk stratification, restrictive transfusion thresholds, Forrest classification, endoscopic dual therapy, OTSC for re-bleed, the acute variceal resuscitation bundle, and salvage TAE. Mallory-Weiss versus Dieulafoy versus aortoenteric fistula sorted off the clinical stem.

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39 MCQs2 podcast episodes
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    Attending-narrated, listen on the commute.
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    5-option vignettes with full wrong-answer teaching.
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What this chapter covers

  • Section 9.1: Initial assessment and pre-endoscopic management

    Upper GI bleeding is a perfusion problem first, a diagnosis problem second, and an endoscopy problem third.

  • Section 9.2: Anticoagulant and antiplatelet management in UGIB

    Reversal in UGIB is a balance between two competing risks: ongoing hemorrhage on one side, and the thrombotic event that the anticoagulant was preventing on the other.

  • Section 9.3: Forrest classification and endoscopic hemostasis modality

    The Forrest classification ties endoscopic appearance to rebleeding risk and to the intensity of intervention required, and the boards expect the candidate to recall the categories, the rebleed rates, and the modality choice for each.

  • Section 9.4: PPI dosing strategy and rebleeding prevention

    Acid suppression after endoscopic hemostasis is the medical adjunct that turns a successful procedure into durable control.

  • Section 9.5: Acute variceal hemorrhage

    Variceal hemorrhage is portal hypertension making itself known through the lowest-resistance escape route in the portosystemic circulation, and the management bundle the boards expect candidates to recite is built on three pillars working together: vasoactive infusion to lower portal pressure, prophylactic antibiotics to prevent infection-driven decompensation, and endoscopic band ligation to stop the active bleed.

  • Section 9.6: Non-ulcer non-variceal causes

    The lesions in this section are the diagnoses that the EGD plus PPI plus EVL framework misses if the lesion is not in the differential at the start.

Podcast episodes

  1. 01

    Nonvariceal UGIB

    This episode covers non-variceal upper GI bleeding, and the thing to hold onto is that it's a sequence, and the order is fixed for a reason: it's a perfusion problem first, a diagnosis problem second, and an endoscopy problem third.

  2. 02

    Variceal and Unusual

    This episode covers acute variceal hemorrhage and the unusual non- variceal causes: the variceal bundle with early TIPS for high-risk patients, and the recognition cues for the lesions a routine scope misses.