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GIGU 2 Exam 1 > Approach To Patient With Lower GI Problems - Dr. McGowen > Flashcards

Approach To Patient With Lower GI Problems - Dr. McGowen Flashcards

1
Q

4 common conditions causing hemarochezia

A
  1. Diverticulosis bleed
  2. IBD
  3. Ischemic colitis
  4. Inteussusception
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2
Q

hemarochezia and under 50yo

A
  1. Infectious colitis
  2. IBD
  3. Anorectal disease (hemorrhoids, anal fissures)
  4. Meckel Diverticulum
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3
Q

hemarochezia and over 50yo

A
  1. Malignancy
  2. Diverticulosis
  3. Arterial problem (AVM, Angiodysplasia, Angioectasia)
  4. Ischemic Colitis
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4
Q

LGIB DX and TX

A
  1. colonscopy, massive do EGD

2. NPO (nothing by mouth), IV , stabilize

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5
Q

how many hematochezias are from UGIB

A

10%

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6
Q

Diverticulosis

prevalence and where

A

most common cause of LGIB

most common in sigmoid colon

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7
Q

Diverticulosis

sx

A

90% are asymptomatic and only see accidentally in colonoscopy, LGIB, PAINLESS**,

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8
Q

Diverticulosis DX and TX

A
  1. colonoscopy if stable, labs until then

2. high fiber diet to prevent constipation (if asymptomatic), NPO and IV or surgery if symptomatic

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9
Q

IBD (UC, CD) risks

A
  1. ABs in 1st year of life
  2. genetics and environment
  3. breastfeeding protects against it
  4. appendectomy before 20yo can protect against UC
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10
Q

IBD (UC, CD) DX

A 
1. serum ANCA = UC
serum ASCA : CD
2. fecal lactoferrin, calpretectin 
3. String sign : (narrowing from inflammation) CD
4. Lead pipe colon : X haustra in UC
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11
Q

IBD (UC, CD) risks TX

A

NPO, surgery, screening for colonoscopy cancer as prevention

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12
Q

CD looks like what

A

= acute ileitis (appendicitis)

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13
Q

CD SX

A

D, Fatigue, Malaise, WL, smoking cigarettes is a huge risk

usually RLQ tenderness

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14
Q

CD DX

A

ASCA serum

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15
Q

CD TX

A

ABs, NGT if obstruction, drain abscesses, surgery only if needed

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16
Q

UC SX

A

Bloody D, fecal urgency (Tenesmus)

Lower abd cramping, relieved when pooping, usually LLQ pain

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17
Q

UC Risk and associated with

A
  1. recently stopped smoking (more incidents in non-smoking pts)
  2. Associations:
    = erythema nodosum
    = Pyoderma gangrenosum
    = Primary sclerosing cholangitis
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18
Q

UC DX

A

ANCA serum

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19
Q

UC Tx

A

surgery can be curative only not first thing ro so

blood transfusion if needed

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20
Q

UC complications

A
  1. Toxic Megacolon –> colonic perforation
  2. colon cancer
  3. Primary Sclerosing cholangitis —-> Cholangiocarcinoma
  4. DVT
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21
Q

extraGI SX of UC

A
  1. Gallstones

2. Nephrolithiasis

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22
Q

extraGI SX of CD

A
  1. Pyroderma Gangrenosum
  2. Toxic megacolon
  3. Ankylosing spondylitis
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23
Q

Ischemic Colitis where and SX

A
  1. Watershed areas : splenic flexures and distal SC

2. Cramping LLQ/LUQ, Bloody D, atherosclerosis, estrogen therapy can cause it

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24
Q

Ischemic Colitis DX

A
  1. Xray = thumb- printing image in colon,

2. Sigmoidoscopy = shows submucosal hemorrhage, friability : risk for perforation= free air under diaphragm

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25
Q

Intussusception risks

A
  1. polyp or mass or Meckels in adults

2. infants common

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26
Q

Intussusception SX

A
  1. Lower ABD pain

2. V, Bloody jelly like stool (currant jelly)

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27
Q

Intussusception Physical exam

A

Dance sign : emptiness feeling when palpating RLQ

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28
Q

Intussusception DX and Tx

A
  1. CT abd + US abd = telescoping bowel (Bulls eye)

2. NPO, IV fluids, surgery

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29
Q

Hemorrhoids how does it happen

A

hydrostatic P increased in hemorrhoidal venous pleux

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30
Q

Hemorrhoids SX

A

Bright Red Blood per rectum (BRBPR) (drops on tissue or in toilet)

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31
Q

Hemorrhoids DX

A

DRE, colonoscopy to rule out other cancer or diseases

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32
Q

Hemorrhoids TX

A
  1. bulk laxatives + stool softerners, sitz baths, witch hazel compresses,
  2. severe bleeding : rubberband ligation, sclerotherapy injection, surgery
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33
Q

Hemorrhoids complications

A

Thrombosed external Hemorrhoids : very painful acute pain, tense blue nodule (pain goes away in 2-3 days) ,sitz baths and analgesics

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34
Q

Anal fissures what is it

A

ulcer less then 5mm in anal skin, usually from pooping, (constipation or straining)

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35
Q

Anal fissures SX

A

sever, tearing pain followed by throbbing pain

can have hematochezia or drops on toilet paper

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36
Q

Anal fissures DX

A

DRE can be too painful
inspection by spreading cheeks
colonscopy to rule out other things

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37
Q

Anal fissures TX

A

fiber supplements, sitz baths, ointments to relax anal canal

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38
Q

Anal Cancer happens how

A

HPV, chronic hemorrhoids, irritations, perianal fissures, LI cancer

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39
Q

Anal Cancer SX

A

analrectal pain, bleeding, othcing, perianal mass, BM changes, DRE mass
= usually SCC or can by adenocarcinoma, melanoma)

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40
Q

Anal Cancer DX

A

Pap anal test, anoscopy, US, DRE

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41
Q

Anal Cancer TX

A

HPV vaccine

chema radiation , surgery,

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42
Q

Perianal Pruritus (pruritus ani) happens how

A
  1. Poor anal hyagine (fissular, hemorrhoids, skin tags)

2. pinworms, staph, strep, STIs, dermititis, soaps that irritate

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43
Q

Perianal Pruritus (pruritus ani) SX and DX

A

perianal itching, and discomfort

DRE and inspection, tape teszt for pinworm, biposy

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44
Q

Occult GI bleed is what and usually from

A
  1. bleeding not seen by pt or physician
    - premenopausal Fm IDA
    - pt with IDA over 45yo think colon cancer
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45
Q

Occult GI bleed DX

A
  1. test for Celiac D if IDA, (IgA anti-Ttg)
    • FOBT (fecal occult Blood test)
    • FIT (fecal immunochemical test)
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46
Q

FOBT

false + and false -

A

Guaiac-based test :

  1. can be + if you eat red meats, Fe+3, asprin, UGIB
  2. can be - if VITC ingesting, intermittent bleeding
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47
Q

FOBT

A

Heme and Hb detection, sensitive

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48
Q

FIT

A

for Hb, most sensitive for colorectal cancer and advanced adenomas (detects human globin)

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49
Q

Fecal DNA tests

A

stool hb, to look at DNA for mutated tumor cells

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50
Q

Colon Cancer : colorectal cancer, adenocarcinoma

who and how

A
  1. greater then 45yo think about it
    2, from polyps
  2. high risk in Strep bovis bacteremia (also called strep gallolyticus)
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51
Q

Colon Cancer : colorectal cancer, adenocarcinoma SX

A
  1. Leser Trelat sign (seb K)

2. bloody stool

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52
Q

Colon Cancer : colorectal cancer, adenocarcinoma RIGTH SIDE SX

A
  1. usually late dx
  2. anemia,
  3. WL, blood in stool
  4. perforations, fistulas, volvulus, inguinal hernia
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53
Q

Colon Cancer : colorectal cancer, adenocarcinoma LEFT SIDE SX

A
  1. rectal bleeding
  2. C, D, narrowing
  3. abd pain, back pain
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54
Q

Colon Cancer : colorectal cancer, adenocarcinoma DX

A
  1. colonoscopy

2. Barium enema (apple core sign*)

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55
Q

Arteriovenous malformations (AVM), Angioectasia happens how and SX

A
  1. occult GIB, painless bleeding
  2. usually over 70yo
  3. common in CRF or Aortic stenosis
  4. IDA can happen with no clear cause
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56
Q

Arteriovenous malformations (AVM), Angioectasia you know it pt shows up and has

A
  1. over 60yo
  2. normal EGD, not WL, ABD pain, neoplasms)
  3. occult bleeding
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57
Q

Unintentional WL is defined as and questions to ask

A
  1. 5% -10% WL in 6mos

2. difficulty eating?, dysgeusia (distorted sense of taste), dysphagia, Anorexia, N, change in BM

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58
Q

Unintentional WL tests and causes

A
  1. poor dentition, oral thrush
  2. DRE, prostate and GI issues
  3. Pelvic exam on females
  4. stool occult blood test
  5. depression
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59
Q

ABD Aortic Aneurism (AAA) risk and SX

A
  1. atherosclerosis, males, FH, HTN, smoking, age

2. asymptomatic usually, non-tender mass felt, abd pulsations, (pain in lower back, chest, scrotum)

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60
Q

AAA that is painful means

A

about to rupture and Medical Emergency

61
Q

ABD Aortic Aneurism (AAA) DX

A

Abd US dx and screening

62
Q

ABD Aortic Aneurism (AAA) prevention

A
  1. US for male over 65yo who have smoked or FH
63
Q

ABD Aortic Aneurism (AAA) TX

A
  1. yearly US for pt asymptomatic AAA

2. >5cm diameter AAA in risk of rupture, surgery

64
Q

ABD Aortic Aneurism (AAA) complications

A
  1. rupture is life threatening (Acute pain, HTN)
  2. AAA leakage, no pain
  3. Aortic dissection : creates a false lumen (CT needed to see) –> usually on right lateral wall
  4. atypical “tearing” CP, widened mediastinum, EM
65
Q

Appendicitis happens how

A

obstruction of Appendix by fecalith, inflammation, foreign body, neoplasm

66
Q

Appendicitis SX

A

vague colicky periumbilical or epigastric pain —-> RLQ pain
= gets worse when coughing of walking

67
Q

Appendicitis TX

A

surgery

AB : gram - and anaerobics

68
Q

Appendicitis unusual pains

A 
RUQ pain (retrocecal appendix)
right subcostal /RLQ /periumbilical pain in pregnant due to uterus displacing the appendix
69
Q

Ectopic pregnancy risks

A
  1. PID, ruptured appendix, tubal surgery

2. most common death in 1st trimester of mother

70
Q

Ectopic pregnancy SX

A

severe LQ pain (right or left)
= 6-8 weeks ofter first period, sudden onset stabbing pain, not radiate,
= blood can accumulate in peritoneum
= orthostatic hypotension, fever

71
Q

Ectopic pregnancy DX

A
  1. Pregnancy test : serum beta-hCG does not double every 48hrs **
  2. US X intrauterine pregnancy (transvaginal US) with elevated serum B-hCG**
72
Q

Ectopic pregnancy TX / DX

A

surgery, pharmacological, shocks, in 10% often after pelvic examination

73
Q

Ovarian Torsion happens how

A 
ovarian enlargement (cysts or masses) = ovary twists crating a fulcrum 
= 70% on right side* (longer utero-ovarian lig)
74
Q

Ovarian Torsion SX

A
  1. sudden severe unilateral L abd pain (can happen after exertion), N, V, fever
  2. gaurding, lower abd tenderness
75
Q

Ovarian Torsion DX

A

Transvaginal US + Doppler

76
Q

Ovarian Torsion TX

A

Surgical EM

77
Q

Acute Colonic Pseudo-obstruction
other name
what is it

A
  1. Ogilvie syndrome

2. spontaneous dilation of cecum or right colon (usually in ICU)

78
Q

Acute Colonic Pseudo-obstruction SX

A

absennt BM, abd distension

79
Q

Acute Colonic Pseudo-obstruction DX

A

Xray, CT : dilation *

over 10cm-12cm = colon perforation

80
Q

Acute Colonic Pseudo-obstruction TX

A
  1. radiographs every 12hrs for size of dilation
  2. recal tube placed
  3. stop all anti-diarrhea drugs
  4. colonoscopic decompression, surgery
81
Q

Meckel’s Diverticulitis is what

A

remnant of Vitelline duct from ileum

82
Q

Meckel’s Diverticulitis looks like what and SX

A
  1. acute appendicitis

2. RLQ pain, N,V, rectal bleeding, reboud/guarding

83
Q

Meckel’s Diverticulitis DX

A
  1. Angiography : see vitelline artery*
  2. Meckel’s scan : technetium-99m scan**
  3. rule of 2** (2ft from ileocecal valve, 2& pop, 2in long, 2 types tissue (gastric or pancreatic)
84
Q

Meckel’s Diverticulitis TX

A

surgery

PPIs

85
Q

Meckel’s Diverticulitis complications

A
  1. intestinal obstruction (intussusception / volvulus) /SBO,
  2. perforation
  3. diverticular inflammation
86
Q

Diverticulitis vs diverticulosis

A

Diverticulitis = no bleeding or hemorrhage usually

87
Q

Diverticulitis is what

A

inflammation of div, microperforation –> macroperforation, abscess

88
Q

Diverticulitis SX

A
  1. acute LLQ pain, fever, N, V, C, loose stools (only liquids can pass due to narrowing)
89
Q

Diverticulitis DX

A

= WBC
= CT + Contrast
= DONT DO : EGD, colonoscopy, sigmoidoscopy, barium enema —- > can cause perforation

90
Q

Diverticulitis TX

A

IV, NPO, ABs, after recovery do colonoscopy or barium enema

surgery

91
Q

Acute mesenteric ischemia (AMI) is what

A

inadequate BF in mesenteric vessels –> ischemia and gangrene of bowel wall (SMA)

92
Q

Acute mesenteric ischemia (AMI) SX

A

Periumbillical pain more then tanderness= gut attack*, red current jelly stools

93
Q

Acute mesenteric ischemia (AMI) DX

A
  1. thumbprinting (submucsal edema)

2. CT angiography + contrast **

94
Q

Acute mesenteric ischemia (AMI) TX

95
Q

Chronic mesenteric ischemia (CMI)

is what

A

= atherosclerosis for long time (celiac A, SMA, IMA) = reduction of BF in GI

96
Q

Chronic mesenteric ischemia (CMI) SX

A
  1. And angina : dull cramping, periumbilical pain, 15-30min (up to 60min) after meals lasting several hours,
  2. WL, D sometimes
97
Q

Chronic mesenteric ischemia (CMI) DX

A
  1. CT angiography abd and pelvis + IV contrast ** see vasculature
  2. Mesenteric arteriography*
98
Q

Chronic mesenteric ischemia (CMI) TX

A

bypass graft surgery

99
Q

Acute SBO usually happens how and SX

A
  1. adhesions*, many surgeries, Crohns disease, diverticulitis
  2. N/V when eating + NO BM**
  3. high pitched tinkling BS**
100
Q

Acute SBO DX

A

Plain ABD radiography (KBU Xray, abd series Xray) ** or CT= dilated loops of SB, air fluid levels

101
Q

Acute SBO TX

A 
Nasogastric tube (NGT)**** to suction 
surgery if that doesnt help
102
Q

Toxic Megacolon is what happens how

A
  1. IBD (UC) complication

2. C. Diff

103
Q

Toxic Megacolon SX

A
  1. tachy, fever, Hypotension, adb pain distension

2. PMH of C.diff or IBD

104
Q

Toxic Megacolon DX

A

WBCs
CT + contrast *
ABD Xray**
= no invasive risk of perforation *

105
Q

Toxic Megacolon TX + complications

A
  1. IVF, ABs, decompression of colon

2. perforation + death

106
Q

Volvulus happen how and where

A
  1. twisting of LI/SI –> LBO –> infarction
  2. sigmoid in preg or elderly constipation = most common
  3. cecum : young adults
107
Q

Volvulus SX

A

bloating, preg, severe abd pain, SBO sxs

108
Q

Volvulus DX

A

Bent Coffee bean sign on Xray **

Birds Bea sing : barium enema

109
Q

Diarrhea is defined as what and length

A

3 or more loose watery stools / day

  • acute : less then 2 weeks
  • subacute : 15days - 4 weeks
  • chronic : 4 weeks
110
Q

Diarrhea blood works

A

WBC : infection
Lose Bicarbonate + Potassium (hypokalemia)
Dehydration

111
Q

AB Associate Diarrhea how does it usually happen and SX

A
  1. adverse effect, not from C.Diff usually, can be ab associated colitis
  2. non-inflammatory, watery
112
Q

Chronic Diarrhea most common causes

A
  1. medications
  2. IBS
  3. Lactose intolarant
113
Q

Chronic Diarrhea 2 types

A
  1. Secretory : normal stool osmotic gap, no change when fasting (high watery D)
  2. Osmotic : increase stool osmotic gap, better when fasting
114
Q

Pathogens causing Chronic Diarrhea

A
  1. Giardia, E. Histolytica, Cryptosporidium = protozoans
  2. Strongyloidiasis Stercoralis = intestinal nematodes
  3. C. Diff, Mycobacterium avium complex = bacteria
  4. CMV, HIV = virus
115
Q

4 things you measure in IBD

A
  1. C-reactive P
  2. leukocytes
  3. Calprotectin
  4. Lactoferrin
116
Q

2 osmotic D

A
  1. lactose

2. IBS

117
Q

IBS is what and happens how

A

Visceral Hyperalgesia to mechanoreceptors stimuli
1. altered colon and SI motility at res, to stress, and drugs
2. lower pain threshold
= can happen after gastroenteritis

118
Q

IBS SX

A
  1. C, D = alternating
  2. abd pain (lower)
  3. no pathology detected
    - onset 30yo, more if F
    - decrease pain with BM
119
Q

IBS DX

A
  1. ROME IV Clinical Dx Criteria *
  2. exclude other diseases
  3. may have psychological problems also (OCD, depression hysteria)
120
Q

IBS TX

A
  • Low FODMAP diet (avoid fat, fermented carbs, alcohol

- tx psychologic problem is present also

121
Q

ALARM SX of chronic osmotic D

A
  1. acute onset, older then 40yo
  2. Nocturnal D
  3. severe D/C
  4. Hematochezia /FOBT + —-> (no blood in IBS only IBD)
  5. WL, F, FH of cancer, IBD
122
Q

Lactase Deficiency happens how

A
  1. lactase enzyme not function or present to make glucose and galactose
  2. proximal SI mucosa LD is secondary LD
123
Q

Lactase Deficiency (secondary diseases)

A
  1. CD, Celiac Disease, Viral gasteroenteritis
124
Q

Lactase Deficiency DX

A

no dairy diets improves sx

hydrogen breath test**

125
Q

C. Diff infection from AB associated Colitis
happen how
what type of bacteria
what ABS

A
  1. Anaerobic gram +, spore forming bacillus making Cytotoxin A + B (fecal oral TR)
  2. elderly, hosp, many ABs, PPI, IBD
  3. ampicillin, Clindamycin, 3rd gen cephalosporins, Fluoroquinolones
126
Q

C. Diff infection from AB associated Colitis SX

A
  1. mild to moderate greenish, foul smelling WATERY D (5-15 times per day)
  2. only bloody if IBD pt (UC)
  3. lower ABD cramping
127
Q

C. Diff infection from AB associated Colitis DX

A
  1. stool for C. Diff Toxins PCR
  2. WBC : > 15,000mcL
  3. Flexible sigmoidoscopy + biopsy : pseudomembranous colitis : yellow adherent plaques (epithelial ulceration volcanic exudate of fibrin and N)
128
Q

C. Diff infection from AB associated Colitis TX

A
  1. monitor for complications
  2. wash hands with SOAP and WATER (not germX)
  3. stop ABs
129
Q

C. Diff infection from AB associated Colitis complications

A

Toxic megacolon (hemodynamic instability —-> perforation —-> death (surgery eeded)

130
Q

Malabsorption syndromes SX

A
  1. D WITH WL
  2. osmotic D
  3. Steatorrhea
  4. Nutritional Deficiency
131
Q

Malabsorption syndromes where and who

A
  1. damage to proximal SI with malabsorption

2. HLA DQ2 DQ8, AB to tTG of gluten

132
Q

Malabsorption syndromes SX

A
  1. Dermatitis herpetiformis

2. D, IDA, ABD dist, pain

133
Q

Malabsorption syndromes DX

A
  1. IgA to tTG (goes away after not eating gluten for 3-12 months)
  2. EGD biopsy : atrophy or scalloping of duodenal folds, loss of intestinal villi
134
Q

Exocrine Pancreatic insufficiency happens from and SX

A
  1. Chronic pancreatitis, CF

2. steatorrhea**, (cant absorb TAGs)

135
Q

Exocrine Pancreatic insufficiency DX

A

Sudan stain : stain for fat
sweat chloride test
abd plain film xray

136
Q

Bile salt malabsorption where and how

A
  1. X bile salts becuz they cant be reabsorbed in terminal ileum **
  2. usually after resecting this part from CD
137
Q

Bile salt malabsorption SX

A
  1. mild steatorrhea
  2. X vit A, D, E, K absorption
  3. bleeding, osteoporosis, hypocalcemia
  4. SECRATORY WATERY D
138
Q

Bile salt malabsorption TX

A

cholestyremine (bile acid resin)

139
Q

Whipple Disease happens how and is what

A
  1. multi-system disease (TROPHERYMA WHIPPLEI)**

2. infection from gram + bacillus (not fast acid)

140
Q

Whipple Disease SX

A
  1. WL
  2. Malabsorption (hypoalbuminemia) = peripheral edema
  3. Chronic D
141
Q

Whipple Disease DX

A
  1. PAS = periodic acid schiff : + M and bacillus
142
Q

Whipple Disease TX + prognosis

A
  1. antibiotic therapy, 1 yr

2. fatal if not Tx

143
Q

pseudo-diarrhea

A
  1. IBS

2. proctits

144
Q

Constipation complications

A
  1. fecal impaction, stercoral ulcers
145
Q

Fecal impaction is what

A
  1. impaction of recal vault can obstruct of fecal flow

2. can be caused from constipation

146
Q

Fecal impaction SX

A
  1. N/V
  2. decreased appetite
  3. abd distention
  4. Paradoxical D : OVERFLOW incontinence (leaks around the impaction)**
  5. Firm feces palpable on DRE
147
Q

Fecal impaction TX

A

enemas, soft stools maintanance, and regular BM

148
Q

Fecal impaction complications

A

melanosis coli (benign hyperpigmentation of the colon)

GIGU 2 Exam 1 (12 decks)

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