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