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General Medicine & Family Medicine > General Surgery/GIT / Blood in Stool > Flashcards

General Surgery/GIT / Blood in Stool Flashcards

1
Q

What are the common causes of lower GI bleeding in newborns?

A
  • Swallowed maternal blood
  • anorectal fissures
  • necrotizing enterocolitis
  • malrotation with volvulus
  • Hirschsprung disease
  • coagulopathy
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2
Q

What diagnosis should you suspect in an infant with nonspecific systemic signs, such as apnea, respiratory failure, lethargy, poor feeding, abdominal distention, vomiting, or diarrhea?

A

Necrotizing enterocolitis (NEC)

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3
Q

What is the hallmark radiographic finding of Necrotizing enterocolitis(NEC)?

A
  • Pneumatosis intestinalis
  • gas bubbles in the bowel wall
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4
Q

What is the major risk factor for NEC?

A

Prematurity

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5
Q

An infant presents with abdominal distension, bilious emesis, and melena. What is your diagnosis?

A

Malrotation with midgut volvulus

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6
Q

What are the common causes of GI bleeding in infants?

A
  • Allergic colitis
  • intussusception
  • Meckel diverticulum
  • Henoch-Schonlein purpura
  • hemolytic uremic syndrome
  • lymphonodular hyperplasia
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7
Q

What are the classic exam findings in an infant with intussusception?

A
  • Currant-jelly stools
  • mass in abdomen
  • vomiting
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8
Q

What is the diagnostic test of choice for intussusception?

A

Ultrasonography or contrast enema

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9
Q

Guaiac positive stools, cutaneous purpura over buttocks and lower extremities, swelling of feet and joint pains in a child suggest what diagnosis?

A

Henoch-Schonelin purpura

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10
Q

What test can be used to differentiate fetal from maternal blood?

A

Apt test

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11
Q

What are the two major causes of iron deficiency in developed countries?

A
  1. GI blood loss
  2. Menstrual blood loss in women
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12
Q

What is the differential diagnosis of occult GI bleeding?

A
  • Colon CA
  • esophagitis
  • peptic ulcer disease
  • gastritis
  • IBD
  • vascular ectasias
  • diverticula
  • celiac disease
  • portal hypertensive gastropathy
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13
Q

The presence of occult GI bleeding, epistaxis, and oral telangiectasias suggests what hereditary syndrome?

A

Osler-Weber-Rendu syndrome (also known as HHT: hereditary hemorrhagic telangiectasia)

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14
Q

False positive occult blood tests can result from ingestion of what?

A
  • Red meat
  • dietary peroxidases (such as turnips and radishes)
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15
Q

False negative results on occult blood tests can result from ingestion of what vitamin?

A

Vitamin C

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16
Q

Minimal bright red bleeding per rectum (BRBPR), or “outlet bleeding” includes what complaints?

A
  • Small amounts of blood on toilet paper after wiping
  • few drops of blood in toilet bowl, or
  • small amounts of blood on surface of stool
17
Q

Minimal bright red bleeding per rectum in this setting: Painless bleeding with defecation

A

Internal hemorrhoids

18
Q

Minimal bright red bleeding per rectum in this setting: Sharp pain with bowel movements

A
  • Anal fissure
  • rectal CA
  • herpes
  • recent anal trauma or
  • instrumentation
19
Q

Minimal bright red bleeding per rectum in this setting: Passage of mucus, straining with defecation, and sense of incomplete evacuation

A

Rectal ulcer

20
Q

Minimal bright red bleeding per rectum in this setting: Abdominal pain, change in bowel habits

A

Colon cancer

21
Q

Maroon stool with intermixed bright red blood (hematochezia) implies bleeding from what part of the GI tract?

A

Proximal colon or small intestine

22
Q

What test can be done in a patient with hematochezia to rule out an upper GI source proximal to the ligament of Treitz?

A

Nasogastric tube lavage or endoscopy

23
Q

A history of melena and/or hematemesis suggests bleeding from what source?

A

Upper GI or slow proximal colon bleeding

24
Q

What are important things to ask for in the history of a patient with rectal bleeding?

A
  • Age
  • systemic symptoms
  • change in frequency or caliber of stools
  • history of inflammatory bowel disease
  • family history of colon cancer
  • history of anal trauma
  • history of pelvic radiation
25
Q

What physical exam is required in the evaluation of rectal bleeding?

A
  • External inspection of anus
  • digital rectal exam, fecal occult blood testing
  • office-based anoscopy or proctoscopy
26
Q

What special measures should you take in a person with ongoing rectal bleeding, transfusion requirement greater than two units of packed red blood cells, or signs of hemodynamic instability?

A
  • Admit to ICU
  • start two large caliber peripheral catheters or central venous line
27
Q

An elderly patient presents with left-sided abdominal pain and rectal bleeding after a recent episode of hypotension after surgery. What is your likely diagnosis?

A

Ischemic colitis

28
Q

What are indications for additional testing in a patient with BRBPR regardless of age?

A
  • Vital sign abnormalities
  • constitutional symptoms
  • change in frequency of stools
  • anemia
  • melena
  • fecal occult blood positive stools
  • family history of familial polyposis
29
Q

What is the diagnostic test indicated when you cannot find a cause for rectal bleeding in a patient under age 50?

A

sigmoidoscopy or colononscopy

30
Q

What is the diagnostic test indicated identified for ANY rectal bleeding in a patient OVER age 50?

A

Colonoscopy

31
Q

What is the recommended evaluation for a patient with occult GI bleeding and anemia or upper GI symptoms?

A

Upper endoscopy and colonoscopy

32
Q

When should you consider endoscopic evaluation in a premenopausal woman with anemia?

A
  • Positive fecal occult blood test
  • anemia out of proportion to menstrual blood loss
  • family history of early GI malignancy
33
Q

What is the grading of internal hemorrhoids?

A

Grade 1: no prolapse.

Grade 2: prolapse with defecation, but reduce spontaneously.

Grade 3: prolapse with defecation, require manual reduction.

Grade 4: prolapsed and cannot be reduced manually.

34
Q

What is the initial treatment for bleeding and grade 1 or 2 hemorrhoids?

A
  • Adding fiber to diet or using fiber supplement with psyllium or methylcellulose
  • ensuring adequate fluid intake
35
Q

What is the best initial treatment for irritation and pruritus associated with hemorrhoids?

A
  • Warm sitz baths
  • hydrocortisone suppositories
  • analgesic creams
36
Q

What is the treatment of acute thrombosed external hemorrhoids not improving within 24 to 48 hours?

A

Surgical evacuation of hemorrhoid with excision of skin overlying it

37
Q

What are the nonsurgical treatment options for grade 1-3 internal hemorrhoids refractory to conservative therapy?

A
  • Rubber band ligation
  • infrared coagulation
  • laser photocoagulation
  • sclerotherapy
  • cryosurgery
  • bipolar diathermy (Bicap)
38
Q

Operative therapy is indicated for hemorrhoids with what characteristics?

A
  • Failure of medical and nonoperative therapy
  • concomitant anorectal condition requiring surgery
  • symptomatic third-degree
  • fourth-degree, or mixed internal and external hemorrhoids
39
Q
A

General Medicine & Family Medicine (150 decks)

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