DSA 4: Melena hematochezia occult GIB DSA Flashcards
How do occult GI bleeds present?
A signs of anemia (fatigue and SOB)
What are common causes of occult bleeding with iron deficiency?
1) Neoplasms
2) Angioectasia
3) IBD (CD more common)
In premenopausal women, iron deficiency anemia is most commonly attributable to?
Menstrual and pregnancy-associated iron loss
How are occult GI bleeds diagnosed?
1) Fecal occult blood test
2) Fecal immunochemical test
During an evaluation of occult bleeding, patients with iron deficiency anemia should be evaluated for what disease with either IgA anti-tissue transglutaminase or duodenal biopsy?
Celiac disease
It is recommended to pursue further evaluation of the small intestine for a source of obscure-occult bleeding in order to exclude?
Small intestinal neoplasm or IBD
What is the first thing you should think of when a patient over 45 presents with occult bleeding and iron deficiency anemia?
A patient over age 60 with a normal endoscopic evaluation and no other worrisome symptoms most commonly have blood loss from?
1) Colon cancer
2) Angioectasias
LGIB is defined as that arising below (distal) to?
Ligament of Treitz
10% of hematochezia is due to?
Upper gastrointestinal source
There is an increased risk of lower gastrointestinal bleeding in patients taking?
1) Aspirin
2) Non-aspirin antiplatelet agents
3) NSAIDs
Liquid medications with red dye, as well as certain foods, such as red Kool-aid™ and beets, can simulate?
Hematochezia
How are lower GI bleeds diagnosed in stable patients?
Colonoscopy
What saclike protrusions of the mucosa are the most common cause of major lower tract bleeding?
From what structure is it most common?
1) Diverticulosis
2) Sigmoid colon
How does diverticulos present?
Acute, painless, large-volume bright red hematochezia in patients over age 50 years
Appendectomy for confirmed appendicitis (before age 20) has what effect on UC?
Antibiotic use within first year of life has what effect on IBD in childhood?
1) May protect against developing UC
2) Increased risk
A patient positive for serum anti-neutrophil cytoplasmic antibodies (ANCA) most likely has what condition?
A patient positive for Serum antibodies to Saccharomyces cerevisiae (ASCA) most likely has what condition?
1) UC
2) CD
What is seen on single contrast barium enema for CD due to narrowing from inflammation or stricture?
What is seen on single contrast barium enema for UC due to loss of haustra?
1) String sign
2) Lead pipe colon
How does crohn’s disease present?
1) Right lower quadrant pain
2) Diarrhea (often without blood)
3) Acute ileitis (mimics appendicitis)
4) Abscesses
5) Strictures
6) Fistulas
How does Ulcerative colitis present?
1) Bloody diarrhea
2) Tenesmus/fecal urgency
3) LLQ pain
4) Recently quit smoking
Which IBD condition leads to toxic megacolon?
UC
Where does CD occur?
Where does UC occur?
1) Anywhere along GI tract and most common site is terminal ileum
2) Colon only and most common site is rectum
Ischemic colitis is an acute vascular obstruction that causes sudden onset of?
1) LLQ pain
2) Desire to defecate
3) Bloody diarrhea
What is seen on abdominal x-ray for ischemic colitis?
Colonic dilation, thumbprint sign
Ischemic colitis is due to susceptible watershed are of?
Splenic flexure
What happens in the early development of familial adenomatous polyposis (FAP)?
Hundreds to thousands of colonic adenomatous polyps and adenocarcinoma
What FAP symptom can be detected at birth?
Hypertrophy of the retinal pigment epithelium
Approximately 90% of FAP patients have a mutation in what gene that is inherited in an autosomal dominant fashion?
APC gene
When is complete proctocolectomy with ileoanal anastomosis recommended for a patient with FAP?
Before age 20
Lynch syndrome (aka Hereditary Nonpolyposis Colon Cancer, HNPCC) causes a lifetime increased risk of?
Colorectal cancer and endometrial cancer
How do the polyps of Lynch syndrome develop?
Undergo rapid transformation over 1–2 years from normal tissue to an adenoma and then to cancer
What is Lynch syndrome due to?
Defect in DNA base-pair mismatch genes MLH1 and MSH2
When is prophylactic hysterectomy and oophorectomy recommended to women with FAP?
At age 40 or once they have finished childbearing
What is characterized by hamartomatous polyps throughout the GI tract (most notably in the small intestine?
Peutz-Jeghers syndrome
How does Peutz-Jeghers syndrome present?
Mucocutaneous pigmented macules on the lips, buccal mucosa, and skin
What is characterized by several (more than ten) juvenile hamartomatous polyps located most commonly in colon?
Familial juvenile polyposis
What does Familial juvenile polyposis cause an increased risk for?
Adenocarcinoma
What is characterized by hamartomatous polyps and lipomas throughout the GI tract trichilemmomas, and cerebellar lesions?
PTEN multiple hamartoma syndrome (Cowden disease)
An increased rate of malignancy from Cowden disease is demonstrated in the?
Thyroid, breast, and urogenital tract
How do most patients with adenomatous and serrated polyps present?
Asymptomatic
If adenomatous and serrated polyps aren’t asymptomatic how does it present?
Intermittent hematochezia
What is the treatment for adenomatous and serrated polyps?
Colonoscopy
At what age is the recommended screening for colon cancer for a patient with no risk factors?
At what age should it be done if they had a first degree relative with colorectal cancer?
At what age should it be done if they have an inherited syndrome such as familial adenomatous polyposis?
1) 45
2) 40 or 10 years before the age of the youngest affective relative
3) 10-12
4) 20-25 or 10 years before the age of the youngest affective relative
Colon cancer (adenocarcinoma) has a high prevalence in patients with what bacteria?
Streptococcus gallolyticus (used to be called Streptococcus bovis bacteremia)
What is the main site of metastasis of colon cancer?
Liver
Which side of the colon presents more commonly with rectal bleeding, altered bowel habits, and abdominal or back pain?
Which side presents with anemia, occult blood in stool, weight loss, and fistulas?
1) Left side
2) Right side
What causes painless bleeding ranging from melena or hematochezia to occult blood loss?
Angioectasias
If angioectasias are proximal to ligament of treitz how does it present?
Melena
Angioectasias is most common in patients over 70 years and in those with?
Chronic renal failure or aortic stenosis
How do hemorrhoids present?
Bright red blood per rectum, usually only drops on tissue or in toilet
What are hemorrhoids due to?
Increased hydrostatic pressure in hemorrhoidal venous plexus
What complication can arise from hemorrhoids which may be precipitated by coughing, heavy lifting, or straining at stool?
Thrombosed External Hemorrhoid
What are linear or rocket-shaped ulcers that are usually less than 5 mm in length due to trauma to the anal canal?
Anal fissures
How do anal fissures present?
Severe pain during defecation with mild associated hematochezia, with blood on the stool
or toilet paper
