Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

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

A

UGIB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

serious lower GI bleeding is more common in _____

A

older men

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

most common cause of major lower GI bleeds

A

diverticulosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what CT disorders are associated w/ diverticulosis

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

sx of diverticulosis

A
  • painless hematochezia

- no abd pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

diagnostic test for diverticulosis

A
  • colonoscopy in stable pts once bleeding subsides

- CBC, chemistry, vital signs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

management for uncomplicated diverticulosis

A

high fiber diet, psyllium extract, anticholinergics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

management for diverticulosis w/ hemorrhage

A
  • two large bore IVs
  • fluid bolus if signs of shock
  • blood transfusion if indicated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

CARD15/NOD2 gene is related to what dz process

A

crohn’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

crypt abscesses are associated with what dz process

A

UC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

which IBD do oral contraceptives increase risk for

A

crohn’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

relationship between smoking and UC and CD

A

UC: may prevent dz
CD: may cause dz

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what infections increase risk for IBD

A

salmonella, shigella, campylobacter, C. diff

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

“string sign” on barium enema

A

crohn’s (narrowing from inflammation or stricture)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

“lead pipe” colon on barium enema

A

UC (loss of haustra)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what stool studies should you order when suspecting IBD

A
  • stool cultures
  • fecal lactoferrin
  • fecal calprotectin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

anti-neutrophilic cytoplasmic antibodies (ANCA) are associated with what dz process

A

UC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

antibodies to saccharomyces cerevisiae (ASCA) are associated with what dz process

A

CD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

labs to order when suspecting crohn’s

A

CBC, CRP, chemistry, ASCA, stool studies for infection and for fecal calprotectin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

imaging to order when suspecting crohn’s

A
  • CT or MRI enterography
  • CT w/ or w/o contrast
  • pelvic MRI (perianal fissures)
  • EGD
  • colonoscopy
  • barium enema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

9 possible crohn dz fistulas

A
  • colovesical
  • enterovesical
  • colovaginal
  • enterovaginal
  • enterocolonic
  • colocutaneous
  • enterocutaneous
  • entero-enteral
  • anorectal
30
Q

compare diarrhea b/w UC and CD

A

CD: with or without blood
UC: bloody w/ mucus

31
Q

sx of ischemic colitis

A

sudden onset of cramping in the LLQ with desire to defecate and passage of blood or bloody diarrhea

32
Q

demographic ischemic colitis

A

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
Q

most common area for ischemic colitis

A

watershed area of splenic flexure

34
Q

imaging results in ischemic colitis

A

abd x-ray shows thumb-printing

sigmoidoscopy shows submucosal hemorrhage, friability, ulcerations

35
Q

thumb-printing on x-ray

A

ischemic colitis or acute mesenteric ischemia

36
Q

sx acute mesenteric ischemia

A

1) periumbilical pain out of proportion to tenderness
2) food fear (abd pain worsens w/ eating)
3) N/V, distention, GI bleeding

37
Q

diagnostic study of choice for acute mesenteric ischemia

A

CT angiography

38
Q

tx/management for acute mesenteric ischemia

A
  • laparotomy to restore intestinal blood flow

- postoperative anticoags

39
Q

sx of hemorrhoids

A

bright red blood per rectum - usually only drops on tissue or in toilet

40
Q

tx hemorrhoids

A

bulk laxatives and stool softeners, sitz baths, witch hazel compresses, analgesics

41
Q

complications of hemorrhoids

A

thrombosed external hemorrhoid

- acute onset of very painful, tense, bluish perianal nodule covered with skin

42
Q

what are anal fissures

A

linear or rocket-shaped ulcers less than 5mm in length

43
Q

causes of anal fissures

A

trauma to anal canal during defecation or by straining from constipation

44
Q

sx anal fissures

A

severe, tearing pain during defecation following by throbbing discomfort
- may have mild hematochezia w/ blood in stool or on toilet paper

45
Q

how to diagnose anal fissures

A

seen on external anal inspection or anoscopy

46
Q

tx for anal fissures

A
  • fiber supplements and sitz baths
  • topical anesthetics
  • internal anal sphincterotomy in some cases
47
Q

causes and sx of proctitis

A

organisms causing inflammation of anal and rectal mucosa

MOST are sexually transmitted

anorectal discomfort, tenesmus, constipation, mucus or bloody discharge

48
Q

how to diagnose a neisseria gonorrhoeae anorectal infection

A

rectal swab during anoscopy

cultures taken from pharynx and urethra in MEN

cultures taken from pharynx and cervix in WOMEN

49
Q

how to diagnose a treponema pallidum anorectal infection

A

dark-field microscopy or fluorescent antibody testing

VDRL or RPR test is positive in 75% primary cases and 99% secondary cases

50
Q

how to diagnose a chlamydia trachomatis anorectal infection

A

serology, culture, or PCR-based testing or rectal discharge or rectal biopsy

51
Q

complication and its sx of anorectal chlamydia infection

A

lymphogranuloma venereum

proctocolitis w/ fever and bloody diarrhea, painful perianal ulcers, anorectal strictures and ulcerations, fistulas, and inguinal adenopathy

52
Q

most common cause of anorectal infection

A

HSV 2

53
Q

how to diagnose an HSV2 anorectal infection

A

viral culture, PCR, or antigen detection assays of vesicular fluid

54
Q

when suspecting a condylomata acuminata anorectal infection what must you distinguish the warts from

A

warts must be distinguished from condyloma lata (secondary syphilis) or anal cancer

55
Q

what infectious agent is associated with anal cancer

A

HPV

56
Q

etiology of perianal pruritis

A

poor anal hygiene associated w/ fistulas, fissures, prolapsed hemorrhoids, skin tags, minor incontinence

57
Q

mutation in MUTYH gene

A

familial adenomatous polyposis

58
Q

treatment/management for FAP

A

complete proctocolectomy with ileoanal anastomosis recommended before age 20

59
Q

DNA base-pair mismatches in genes MLH1, MSH2, MSH6, PMS2

A

lynch syndrome (HNPCC)

60
Q

treatment/management in all patients and just women with HNPCC

A

all pts: subtotal colectomy w/ ileorectal anastomosis

women: prophylactic hysterectomy and oophrectomy at age 40 or once they have finished childbearing

61
Q

how to diagnose lynch syndrome (HNPCC)

A

genetic testing

62
Q

sx and diagnostic test for nonfamilial adenomatous and serrated polyps

A

most are completely asymptomatic with maybe intermittent hematochezia from ulcerated polyps

colonoscopy

63
Q

sx of PTEN multiple hamartoma syndrome (Cowden dz)

A

hamartomatous polyps and lipomas throughout the GI tract

trichilemmomas and cerebellar lesions

64
Q

regular screening recommendations and above average risk screening recommendations for colorectal cancer

A

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
Q

most colon cancers arise from _____

A

adenomatous polyps

66
Q

there is a high prevalence of colon cancers in pts with what infectious organism

A

streptococcus bovis

67
Q

early diagnosis of colon cancer is aided by screening asymptomatic pts with _____

A

fecal occult blood testing

68
Q

diagnostic testing for colon cancer

A

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
Q

sx of angioectasia (angiodysplasias)

A

painless bleeding ranging from melena or hematochezia to occult blood loss

70
Q

demographic of angioectasia

A

pts over 70 and those with chronic renal failure or aortic stenosis

71
Q

diagnostic studies for angioectasia

A

1) CBC w/ iron studies

2) endoscopic workup

72
Q

most useful method of diagnosis for meckel’s diverticulum

A

technetium 99 scan

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

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions