CIS 2: GI Case Flashcards
Tearing pain w/ the passage of bowel movements, a small amount of blood on the TP or on surface of stool is indicative of?
Anal fissures
Abdominal pain followed by profuse bleeding is indicative of?
Ischemic colitis
During PE of someone with GIB what is the first thing that needs to be assessed/established?
Hemodynamic instability
What sign/sx is associated w/ blood volume loss of at least 15%?
Orthostatic hypotension or increase in HR of 20 bpm
What sign/sx is associated w/ blood volume loss of at least 40%?
Supine hypotension
What is a clinical finding associated with mild to moderate hypovolemia?
Resting tachycardia
What is the BUN:Cr ratio in an upper GI bleed?
30:1
Abruptly stopping a beta-blocker can lead to?
Rebound sinus tachycardia
How fast can KCl be given through a peripheral IV without being irritating to the vein?
10 mEq per hour
Giving 1 unit of PRBC’s should increase HgB by how much?
1 g/dL
Which skin manifestation is a common finding in those w/ IBD?
Erythema Nodosum
What is the initial management of an acute lower GI bleed?
- Supportive: IV access
- Appropriate setting (outpatient/inpatient/ICU)
- O2 + IVF + blood products
- Assessment and management of coagulopathies
In patients with ongoing lower GI bleeding or high-risk clinical features what needs to be performed and how soon?
- Colonoscopy
- Within 24 hrs of presentation after adequate colon prep
Prepping a resuscitated pt with lower GI bleed for colonoscopy requires 4-6 L of polyethylene glycol, which can be given how if the patient is not able to get the formula down on their own?
Nasogastric tube
What should be done first if considering blood transfusion w/ packed RBC’s in a pt with lower GI bleed that has stable hemoglobin and no acute bleed?
Type and screen
Young pts w/o comorbid illness may not require transfusion until the hemoglobin is at what level?
<7 g/dL
Older patients and those who have severe comorbid illnesses such as CAD require hemoglobin to stay above what level?
≥9 g/dL
Which patients may require a blood transfusion despite apparently normal levels of hemoglobin?
Pts w/ active bleed AND hypovolemia
If considering a blood transfusion, but need iron studies, when must they be taken?
BEFORE tranfusion because will be inaccurate afterwards
Which diagnostic imaging technique used for lower GIB is noninvasive, sensitive to low rates of bleeding and can be repeated for intermittent bleeding?
Radionuclide imaging
Which widely available diagnostic imaging technique used for lower GIB is noninvasive, accurately localizes bleeding source, and provides anatomic detail?
CT angiography
What are 4 potential serious complications of a patient w/ UC?
- Toxic Megacolon (emergency surgery –> colectomy)
- Primary sclerosing cholangitis (M>F)
- Ankylosing spondylitis
- Pyoderma gangrenosum
What are 5 potential complications or risks for someone with Chron Disease?
- Fistulas/strictures
- Fissures
- Pigmented gallstones
- Malabsorption
- Kidney stones
UC and Chron disease are both associated with an increased risk for what bleeding disorder?
DVT
Retroperitoneal hemorrhage may be apparent on PE as the Cullen or Grey Turner Sign, describe the location for each.
- Cullen = peri-umbilical ecchymosis
- Grey Turner sign = flank ecchymosis
Colorectal cancer screening should begin at what age in a healthy person w/ life expectancy >10 year?
Should continue until what age?
- Begin at age 45
- Until age 75
At what age are people no longer screen for colorectal cancer?
over 85
What is the recommended screening for colorectal cancer in pt w/ first-degree relative w/ colorectal cancer diagnosed at age ≤60 yo or two first-degree relatives at any age?
How often should they be screened?
Every 5 years beginning at age 40 or 10 years before the age of youngest affected relative (whichever is first)
In pt w/ family history of FAP, they should be referred for genetic testing and a sigmoidoscopy should be performed starting at what age?
Age 10-12 yo
In pt w/ family hx of HNPCC (aka Lynch) syndrome they should be referred for genetic testing and colonscopy should be performed how often and beginning at what age?
Every 1-2 yrs beginning at age 20-25 yo; or 10 years younger than youngest age of colorectal cancer dx in family
What are the 2 stool based screening tests for colorectal cancer that can be done annually?
- gFOBT
- FIT
Which stool based screening test for colorectal cancer has improved accuracy compared with FOBT and can be done with a single specimen?
FIT
How often can you use FIT-DNA screen for colorectal cancer?
Every 1-3 years
What is a pro and con of using FIT-DNA vs. FIT for screening of colorectal cancer?
- Specificity is lower than FIT = more false positives, more diagnostic colonoscopies, and more associated AE’s per screening test
- Improved sensitivity compared w/ FIT per single screening test
What is the gold standard direct visualization screening test for colorectal cancer?
How often is it performed?
Colonoscopy every 10 years
What are 2 direct visualization screening tests for colorectal cancer that can be done every 5 years?
- CT colonography
- Flexible sigmoidoscopy
Which form of IBD shows non-caseating granulomas on histology?
Chron’s
What are 4 prophylactic treatments for DVT’s?
- Sequentiall compression stockings/devices (SCDs)
- TED hose (compression hose)
- Anticoagulation
- Early ambulation
Before beginning tx w/ azathiopurine what needs to be checked?
TPMT enzyme activity
Before starting an immunomodulatory or biologic medication to treat IBD what things need to be checked?
- PPD skin test for Quantiferon gold (+/- CXR) for TB
- Viral hepatitis serology
What are 4 risk factors for AAA?
- Age >65
- Hx of smoking
- Male gender
- First-degree relative w/ hx of AAA repair
In pts >50 yo a normal aorta is no more than how many cm wide?
3cm wide (average, 2.5 cm)
What 2 screening methods for AAA decrease mortality in male smokers 65 yo or older?
Palpation followed by US
Rupture of an AAA is 15x more likely in an AAA of what size?
>4cm
A periumbilical or upper abdominal mass w/ expansile pulsations that is 3cm or more wide suggests?
AAA
What does it mean for an IV to be locked (i.e., saline lock or heparin lock)?
Not hooked up to any infusion, is flushed w/ saline or heparin and then locked
What are the cc/hr of IVF of NS for maintenance?
125 cc/hr
IVF at NS 1 liter bolus is used when what is needed?
Wide open, need rapid-rehydration
What are 2 unacceptable treatments to someone who is a Jehovah’s witness?
1) Transfusion of allogenic whole blood, RBC’s, white cells, platelets, or plasma
2) Preoperative autologous blood donation (PAD or predeposit)
Collateral ganglia inhibition of which 2 ganglia are relevant for UC?
1) Superior mesenteric ganglia
2) Inferior mesenteric ganglia
Posterior Chapman’s point for colon?
TP of L2 to TP of L4, extending laterally to iliac crest
Posterior Chapman’s point for Rectum?
Sacrum, at lower end of SI articulation bilaterally
What is the expected span when palpating the liver and should be felt where?
6-12 cm at the mid-clavicular line on right
What is the expected span of the spleen when palpating and where should it be felt?
From ribs 6-10 at the mid-axillary line
Rebound tenderness is testing for what?
Peritoneal inflammation
