Dr. Michael Chew @mchew85
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GrepMed Gastroenterology-Hepatology Editor, Academic Hospitalist UC Davis Medical Center Internal Medicine, Yale Gastroenterology Fellow '22
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Forrest Classification for Peptic Ulcer Bleeding
Rebleeding risks are without endoscopic intervention
1a - Spurting Bleed - 60-100%
Forrest Classification ... for Peptic Ulcer Bleeding ... IIa - Non-Bleeding ... #Forrest #Classification ... gastroenterology #EGD
Endoscopic Bleeding Risk - Summary points from ASGE guideline 

Low Risk Procedures 
 - Diagnostic endoscopy
Endoscopic Bleeding ... forceps biopsy (EGD ... Endoscopy #Endoscopic #Bleeding ... Gastroenterology #EGD ... HighRisk #Diagnosis #Management
Acute Esophageal Necrosis
History: Hematemesis and/or melena (70%), Dysphagia, Epigastric/chest pain, Sepsis
Diagnosis EGD and Biopsy
Differential: Melanosis, Melanoma,
Sepsis Diagnosis EGD ... Klebsiella, pneumoniae) Management ... Esophageal #Necrosis #black ... esophagus #diagnosis #management
Classification of the stigmata of bleeding ulcers, including prevalence and risks of further bleeding; 

A, clean
Classification of ... the stigmata of bleeding ... risks of further bleeding ... vessel; E, active bleeding ... Prevalence #Stigmata #EGD
Endoscopy - Management of Bleeding Esophageal Varices 
What to Band?
 - Always find the varix that
Endoscopy - Management ... EGD and the Banding ... adequately, pull back ... #Tips #Tricks #management ... fellows #endoscopy #egd
Management algorithm for patients presenting with acute lower gastrointestinal bleeding. 

Shock index (SI) is calculated by
Management algorithm ... gastrointestinal bleeding ... interventional radiology; OGD ... #Management #algorithm ... #lower #GIBleeding
Hepatocellular Carcinoma (HCC) in Cirrhosis - Management Algorithm

Very early (0) - Single <2 cm, Preserved liver
in Cirrhosis - Management ... Algorithm Very ... transplantable HCC, End-stage ... HCC #Cirrhosis #Management ... #Algorithm #hepatology
Spontaneous Bacterial Peritonitis (SBP) - Diagnosis and Management
Ascites PMN > 250/mm3
? Nosocomial or hospital acquired. Recent
Diagnosis and Management ... SBP: Medical Management ... baseline indicates lack ... acceptable Upper Gl bleeding ... SBP #Diagnosis #Management
Antibiotic Prophylaxis for Endoscopy (ASGE 2015) 

Give Antibiotics: 
 - PEG tube placement (or PEG-J)
Cirrhosis & GI bleeding ... Prophylaxis #Endoscopy #EGD ... Gastroenterology #Management
Refractory Ascites - Ascites that cannot be mobilized or early recurrence that cannot be prevented
Diuretic Resistant:
Diuretic Resistant: Lack ... mobilization Lack ... Ascites #diagnosis #management ... #algorithm #treatment