Teaching Pearls:

MKSAP Boards Question Review – Bipap has been shown to decrease mortality, decrease need for intubations, and decrease hospital stay in select patients with COPD exacerbations.

• Definitions
  • Overt Bleeding – GI bleed that is clinically evident. Hematemesis, hematochezia, melena, etc
  • Occult Bleeding – Slow bleed manifested by iron deficiency anemia and/or positive guiac tests
  • Obscure Bleeding – Evident GI bleed without clear source of bleed despite standard work-up
• Common etiologies for obscure occult GI bleed
  • Angioectasia
  • Cameron lesions
  • NSAID ulcer
  • Malignancy
• Common etiologies for obscure overt GI bleed
  • Dieulafoy lesion
  • Meckel’s diverticulum
  • Angioectasia
  • Colonic diverticulum
• Tachycardia suggests blood loss of 15-30%. Patients develop hypotension once blood loss >30%.
• If unable to find source with EGD/colo, next step is to perform EGD and/or colonoscopy again as 30-50% can be identified
• Capsule – can detect lesions without active bleeding. Diagnostic in 50-75% of cases. Only offers diagnostic benefits
• Tagged RBC scan – good sensitivity but poor specificity. Does not offer therapeutic intervention. Ideal for bleeds 0.1-0.5cc/min.
• Angiography – best for overt bleeding (>1cc/min), allows for immediate therapy.
• Chronic Hepatitis B Treatment Goals:
  • Treat HBeAg Positive patients if:
    • ALT>2xULN
    • HBV DNA >20,000IU/ml
  • Treat HBeAg Negative patients if:
    • ALT>2xULN
    • HBV DNA >2,000IU/ml