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Maddy - GI II Exam I - some pharm > Clin - Melena and Hematochezia > Flashcards

Clin - Melena and Hematochezia Flashcards

1
Q

compare ddx for lower GI bleed in patients under and over 50

A

under 50:

  • infectious colitis
  • anorectal dz (anal fissures, hemorrhoids)
  • IBD
  • meckel diveritculum

over 50:

  • malignancy
  • diverticulosis
  • angiectasias
  • ischemic colitis
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2
Q

which is more likely to present with shock or orthostasis and require transfusions: UGIB or LGIB

A

UGIB

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3
Q

serious lower GI bleeding is more common in _____

A

older men

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4
Q

notable PMH for pts with lower GI bleeds

A

1) prior GI bleeding
2) hx of aortic stenosis, renal dz
3) liver dz (portal HTN?)
4) IBD or diverticular dz
5) ETOH abuse

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5
Q

notable prior medications in pts with lower GI bleeds

A

1) NSAIDS, anticoags
2) meds w/ iron or bismuth (make stool darker)
3) liquid meds w/ red dye and certain red foods

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6
Q

diagnostic tests in pts with lower GI bleeds

A

1) colonoscopy in stable pts
2) anoscopy
3) EGD or sigmoidoscopy in massive active bleeding

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7
Q

tx/management for pts with lower or upper GI bleeds

A

1) 2 large bore IVs
2) fluid bolus if signs of shock
3) blood transfusion if indicated
4) CBC, INR/Pt/Ptt

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8
Q

what is diverticulosis

A

herniations or saclike protrusions of mucosa through muscularis at points of nutrient artery penetration

  • most common cause of major lower GI bleed
  • most common in sigmoid colon
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9
Q

most common cause of major lower GI bleeds

A

diverticulosis

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10
Q

what CT disorders are associated w/ diverticulosis

A

1) ehler’s-danlos
2) marfan
3) scleroderma

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11
Q

sx of diverticulosis

A
  • painless hematochezia

- no abd pain

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12
Q

diagnostic test for diverticulosis

A
  • colonoscopy in stable pts once bleeding subsides

- CBC, chemistry, vital signs

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13
Q

management for uncomplicated diverticulosis

A

high fiber diet, psyllium extract, anticholinergics

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14
Q

management for diverticulosis w/ hemorrhage

A
  • two large bore IVs
  • fluid bolus if signs of shock
  • blood transfusion if indicated
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15
Q

CARD15/NOD2 gene is related to what dz process

A

crohn’s

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16
Q

crypt abscesses are associated with what dz process

A

UC

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17
Q

which IBD do oral contraceptives increase risk for

A

crohn’s

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18
Q

relationship between smoking and UC and CD

A

UC: may prevent dz
CD: may cause dz

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19
Q

what events in the first year of life can affect risk for UC and CD

A

antibiotic use: 2.9x increased risk of IBD

breastfeeding: can be protective

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20
Q

what infections increase risk for IBD

A

salmonella, shigella, campylobacter, C. diff

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21
Q

what dietary factors can increase risk for IBD

A

high animal protein, sugars, sweets, oils, fish, high omega 6 and low omega 3

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22
Q

“string sign” on barium enema

A

crohn’s (narrowing from inflammation or stricture)

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23
Q

“lead pipe” colon on barium enema

A

UC (loss of haustra)

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24
Q

what stool studies should you order when suspecting IBD

A
  • stool cultures
  • fecal lactoferrin
  • fecal calprotectin
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25
anti-neutrophilic cytoplasmic antibodies (ANCA) are associated with what dz process
UC
26
antibodies to saccharomyces cerevisiae (ASCA) are associated with what dz process
CD
27
labs to order when suspecting crohn's
CBC, CRP, chemistry, ASCA, stool studies for infection and for fecal calprotectin
28
imaging to order when suspecting crohn's
- CT or MRI enterography - CT w/ or w/o contrast - pelvic MRI (perianal fissures) - EGD - colonoscopy - barium enema
29
9 possible crohn dz fistulas
- colovesical - enterovesical - colovaginal - enterovaginal - enterocolonic - colocutaneous - enterocutaneous - entero-enteral - anorectal
30
compare diarrhea b/w UC and CD
CD: with or without blood UC: bloody w/ mucus
31
sx of ischemic colitis
sudden onset of cramping in the LLQ with desire to defecate and passage of blood or bloody diarrhea
32
demographic ischemic colitis
1) older patients w/ atherosclerotic dz 2) younger patients on vaso-occlusive recreational drugs (cocaine) 3) pts w/ vasculitis, coag disorders, estrogen therapy, long distance running
33
most common area for ischemic colitis
watershed area of splenic flexure
34
imaging results in ischemic colitis
abd x-ray shows thumb-printing sigmoidoscopy shows submucosal hemorrhage, friability, ulcerations
35
thumb-printing on x-ray
ischemic colitis or acute mesenteric ischemia
36
sx acute mesenteric ischemia
1) periumbilical pain out of proportion to tenderness 2) food fear (abd pain worsens w/ eating) 3) N/V, distention, GI bleeding
37
diagnostic study of choice for acute mesenteric ischemia
CT angiography
38
tx/management for acute mesenteric ischemia
- laparotomy to restore intestinal blood flow | - postoperative anticoags
39
sx of hemorrhoids
bright red blood per rectum - usually only drops on tissue or in toilet
40
tx hemorrhoids
bulk laxatives and stool softeners, sitz baths, witch hazel compresses, analgesics
41
complications of hemorrhoids
thrombosed external hemorrhoid | - acute onset of very painful, tense, bluish perianal nodule covered with skin
42
what are anal fissures
linear or rocket-shaped ulcers less than 5mm in length
43
causes of anal fissures
trauma to anal canal during defecation or by straining from constipation
44
sx anal fissures
severe, tearing pain during defecation following by throbbing discomfort - may have mild hematochezia w/ blood in stool or on toilet paper
45
how to diagnose anal fissures
seen on external anal inspection or anoscopy
46
tx for anal fissures
- fiber supplements and sitz baths - topical anesthetics - internal anal sphincterotomy in some cases
47
causes and sx of proctitis
organisms causing inflammation of anal and rectal mucosa MOST are sexually transmitted anorectal discomfort, tenesmus, constipation, mucus or bloody discharge
48
how to diagnose a neisseria gonorrhoeae anorectal infection
rectal swab during anoscopy cultures taken from pharynx and urethra in MEN cultures taken from pharynx and cervix in WOMEN
49
how to diagnose a treponema pallidum anorectal infection
dark-field microscopy or fluorescent antibody testing VDRL or RPR test is positive in 75% primary cases and 99% secondary cases
50
how to diagnose a chlamydia trachomatis anorectal infection
serology, culture, or PCR-based testing or rectal discharge or rectal biopsy
51
complication and its sx of anorectal chlamydia infection
lymphogranuloma venereum proctocolitis w/ fever and bloody diarrhea, painful perianal ulcers, anorectal strictures and ulcerations, fistulas, and inguinal adenopathy
52
most common cause of anorectal infection
HSV 2
53
how to diagnose an HSV2 anorectal infection
viral culture, PCR, or antigen detection assays of vesicular fluid
54
when suspecting a condylomata acuminata anorectal infection what must you distinguish the warts from
warts must be distinguished from condyloma lata (secondary syphilis) or anal cancer
55
what infectious agent is associated with anal cancer
HPV
56
etiology of perianal pruritis
poor anal hygiene associated w/ fistulas, fissures, prolapsed hemorrhoids, skin tags, minor incontinence
57
mutation in MUTYH gene
familial adenomatous polyposis
58
treatment/management for FAP
complete proctocolectomy with ileoanal anastomosis recommended before age 20
59
DNA base-pair mismatches in genes MLH1, MSH2, MSH6, PMS2
lynch syndrome (HNPCC)
60
treatment/management in all patients and just women with HNPCC
all pts: subtotal colectomy w/ ileorectal anastomosis women: prophylactic hysterectomy and oophrectomy at age 40 or once they have finished childbearing
61
how to diagnose lynch syndrome (HNPCC)
genetic testing
62
sx and diagnostic test for nonfamilial adenomatous and serrated polyps
most are completely asymptomatic with maybe intermittent hematochezia from ulcerated polyps colonoscopy
63
sx of PTEN multiple hamartoma syndrome (Cowden dz)
hamartomatous polyps and lipomas throughout the GI tract trichilemmomas and cerebellar lesions
64
regular screening recommendations and above average risk screening recommendations for colorectal cancer
regular: start at age 45 through age 75, ages 76-85 based on preference, no need after 85 above average: every 5 years beginning at age 40 or 10 years before age of youngest affected relative
65
most colon cancers arise from _____
adenomatous polyps
66
there is a high prevalence of colon cancers in pts with what infectious organism
streptococcus bovis
67
early diagnosis of colon cancer is aided by screening asymptomatic pts with _____
fecal occult blood testing
68
diagnostic testing for colon cancer
1) fecal occult blood testing 2) sigmoidoscope (reaches 60cm) 3) air contrast barium enema (will diagnose 85% cancers not within reach of sigmoidoscope) 4) colonoscopy (most specific)
69
sx of angioectasia (angiodysplasias)
painless bleeding ranging from melena or hematochezia to occult blood loss
70
demographic of angioectasia
pts over 70 and those with chronic renal failure or aortic stenosis
71
diagnostic studies for angioectasia
1) CBC w/ iron studies | 2) endoscopic workup
72
most useful method of diagnosis for meckel's diverticulum
technetium 99 scan

Maddy - GI II Exam I - some pharm (23 decks)

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