12: Lower GI Bleed

Question 1

Four major causes of lower GIB in pts under 50

Answer 1

1. Infectious colitis
2. IBD
3. Anorectal disease
4. Meckel diverticulum

Question 2

Four major causes of lower GIB in pts over 50

Answer 2

1. Malignancy
2. Diverticulosis
3. AVM
4. Ischemic colitis

Question 3

Cutoff pt between upper and lower GIB

Answer 3

Ligament of Treitz

Question 4

What % of hematochezia is due to lower vs upper GIB**

Answer 4

Lower = 90%
Upper = 10%

Question 5

Treatment for acutely ill pt with IBD

Answer 5

1. NPO, IV fluids thru 2 large bore IVs
2. Abx if needed
3. NG tube to suction if obstruction
4. Reverse coagulopathy if needed
5. Surgery if needed
6. IBD drugs

Question 6

Presentation of a thrombosed external hemorrhoid

Answer 6

Acute onset, super painful, bluish perianal nodule covered by skin; pain is most severe in first few hours and gradually eases over a few days

Question 7

Common spot for metastasis for anal cancer and why

Answer 7

Lungs - systemic paravertebral venous drainage of this area