51.3 🩺 內科專科考前版

51.3.0.1 📌 䞀頁重點

  • 22EDOAC reversal、TIPS earlier in variceal、capsule endoscopy / device-assisted enteroscopy
  • Taiwan: HCV / HBV cirrhosis 倚
  • DOAC use 䞊升 → reversal 重芁

51.3.0.2 💊 進階

51.3.0.2.1 Variceal Bleeding
  • Pre-emptive TIPS for high-risk (Child B/C, HVPG > 20)
  • BBL (band ligation) preferred
  • Vasoactive 3-5 days
  • Antibiotic 7 days
  • Carvedilol > propranolol for prevention
51.3.0.2.2 Anticoagulation Reversal
  • Idarucizumab 5 g IV (dabigatran)
  • Andexanet alfa (apixaban, rivaroxaban) — high cost
  • 4F-PCC alternative
  • FFP slower
51.3.0.2.3 Refractory UGIB
  • Repeat EGD
  • IR embolization
  • Surgery (rare now)
  • TIPS for variceal
51.3.0.2.4 Obscure GI Bleed (now “small bowel bleeding”)
  • Capsule endoscopy
  • Device-assisted enteroscopy (single/double balloon)
  • CT enterography
  • Tagged RBC scan
  • Angiography
51.3.0.2.5 Lower GI Bleed
  • Colonoscopy < 24h
  • Embolization for refractory
  • Surgery (transmural ischemia, persistent)

51.3.0.3 🌟 Pearls (10)

  1. Variceal pre-emptive TIPS Child B/C high-risk
  2. Carvedilol > propranolol for variceal prevention
  3. Cirrhotic Abx must (mortality benefit)
  4. DOAC reversal standard
  5. Capsule endoscopy for obscure
  6. Heyde syndrome AVR cures
  7. Aortoenteric fistula post-AAA → 臎呜
  8. Hemosuccus pancreaticus (pancreatic pseudoaneurysm)
  9. Hemobilia: Quincke triad (RUQ pain + jaundice + UGIB)
  10. Stress ulcer prophylaxis ICU only with risk factors

51.3.0.4 📍 Taiwan Context

  • HCV / HBV cirrhosis 倚 → variceal
  • 健保 EGD / colonoscopy
  • DOAC use 䞊升
  • Idarucizumab / andexanet 自費 / 限定

51.3.0.5 🎓 內專重點

  1. UGIB / LGIB workup + treatment
  2. Variceal management
  3. Forrest classification
  4. Reverse anticoagulation
  5. Refractory bleed (TIPS, IR)
  6. Obscure bleed workup

⚠ AI 草皿。