51.2 📚 國考版醫垫國考 / PGY OSCE

51.2.0.1 📌 Cram Sheet

51.2.0.1.1 🔥 高 yield 10
  1. UGIB vs LGIB (Treitz ligament)
  2. UGIB peptic ulcer 50%
  3. Variceal mortality 20-30%
  4. Cirrhotic UGIB → ceftriaxone (reduce SBP, mortality)
  5. Octreotide / terlipressin for variceal
  6. Hgb < 7 transfuse (< 8 cardiac, > 9 variceal)
  7. Glasgow-Blatchford for UGIB risk
  8. Heyde syndrome = AS + GI angiodysplasia
  9. Diverticular bleed = LGIB 老人最垞
  10. Reverse anticoagulation: idarucizumab (dabigatran), andexanet (factor Xa)
51.2.0.1.2 🔢 必背
項目 æ•žå­—
Hgb transfuse general < 7
Hgb transfuse cardiac < 8
Variceal Hgb target > 9
UGIB EGD timing < 24h (active < 12h)
LGIB colonoscopy timing < 24h
Pantoprazole bolus 80 mg + 8 mg/h
Octreotide bolus 50 ÎŒg + 50 ÎŒg/h
Cirrhotic Abx Ceftriaxone 1g/d

51.2.0.2 ⭐ 高 yield

51.2.0.2.1 UGIB Etiology
  • Peptic ulcer (50%)
  • Varices (cirrhotic)
  • Mallory-Weiss
  • Erosive esophagitis / gastritis
  • Dieulafoy
  • Aortoenteric fistula (post-AAA repair)
  • Hemobilia
51.2.0.2.2 LGIB Etiology
  • Diverticular (most elderly)
  • Angiodysplasia
  • Hemorrhoids
  • IBD
  • Colon cancer
  • Ischemic colitis
  • Post-polypectomy
51.2.0.2.3 Glasgow-Blatchford Score
  • BUN, Hgb, BP, HR, melena, syncope, cardiac/hepatic dz
  • 0 = outpatient OK
  • ≥ 6 = high risk
51.2.0.2.4 Forrest Classification (peptic ulcer endoscopic)
  • Ia: spurting → high rebleed
  • Ib: oozing
  • IIa: visible vessel
  • IIb: adherent clot
  • IIc: pigmented spot
  • III: clean base → low rebleed
51.2.0.2.5 Variceal Mx
  • IVF + transfuse
  • Octreotide / terlipressin / vasopressin
  • Ceftriaxone 1 g/d × 7 d
  • EGD with band ligation (EVL) > sclerotherapy
  • TIPS for refractory
  • BB primary/secondary prevention
  • Carvedilol > propranolol
51.2.0.2.6 Reverse Anticoagulation
  • Warfarin: vit K + FFP / 4F-PCC
  • Heparin: protamine
  • Dabigatran: idarucizumab
  • Apixaban / rivaroxaban: andexanet alfa or 4F-PCC
  • Antiplatelet: platelet transfusion (limited evidence)

51.2.0.3 🎯 自我檢枬

  1. UGIB vs LGIB anatomic? → Treitz ligament
  2. Cirrhotic UGIB Abx? → Ceftriaxone
  3. Variceal Hgb target? → > 9
  4. Forrest Ia? → Spurting (high rebleed)
  5. Heyde syndrome? → AS + colonic angiodysplasia
  6. Dabigatran reverse? → Idarucizumab
  7. UGIB EGD timing? → < 24h, active < 12h
  8. Diverticular bleed location? → Right > left

⚠ AI 草皿。