GI #2 Flashcards by Tyler Cichowski

Management of fecal impaction

Digital disimpaction followed by warm-water enema with mineral oil
Polyethylene Glycol

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MCC of anorectal abscess

-Staphyloccus Aureus

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MC site of anorectal abscess

Posterior rectal wall

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Symptoms of an anorectal abscess

Swelling
Rectal pain worse with sitting, coughing, defecation
Focal edema, induration, and fluctuance

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Treatment for anorectal abscess/fistula

Incision and drainage

- -Followed by WASH (warm water cleaning, analgesic, sitz baths, high-fiber diet)

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Causes of anal fissures

Low-fiber diet
Passage of large hard stools
Constipation
Other anal trauma

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Symptoms of anal fissures

Severe rectal pain with bowel movements

- bright red blood per rectum

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Describe the MC type and location of anal fissure

-Longitudinal tear at posterior midline

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True or False: 80% of anal fissures resolve spontaneously

True

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However, what is the treatment for an anal fissure if it does not resolve?

Supportive measures (warm water sitz baths, analgesics, high fiber diet, laxatives, mineral oil)

-Topical vasodilators, Nitroglycerin, Botox injections, Surgery for refractory cases

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Internal hemorrhoids originate from ________ and what symptoms do they have?

Proximal (above) the dentate line

-Bleed and are painless

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Describe the four grades of internal hemorrhoids

Grade I: does not prolapse
Grade II: prolapses with defecation but spontaneously reduces
Grade III: Requires manual reduction
Grade IV: Irreducible and may strangulate

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External hemorrhoids originate from ________ and have symptoms such as

Distal (below) dentate line

- Do not bleed and are painful

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Management of hemorrhoids

Conservative treatment: high fiber, increased fluids, warm sitz baths, topical corticosteroids
Rubber band ligation, sclerotherapy, infrared coagulation
Hemorrhoidectomy: for Stage IV or non responsive to other therapy, or external hemorrhoids

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Regarding diverticulosis, what is the MC area for occurrence and what is the MC area for bleeding?

Left colon (MC in incidence)

- Right colon (MC in bleeding)

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Risk factors for diverticulosis

Low fiber diet
Constipation
Obesity

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What is the MCC of acute lower GI bleeding (Painless hematochezia) in adults?

Diverticulosis

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What is the diagnostic of choice for diverticulosis?

Colonoscopy

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If bleeding is not visualized on colonoscopy for diverticulosis, what is the next diagnostic step?

Radionuclide imaging followed by arteriography

In most cases of diverticulosis, the bleeding stops spontaneously. However, if it does not, what should you do?

-Resuscitation (2 large bore IVs, fluids, blood products)

Asymptomatic diverticulosis can be followed by (3 things)

High fiber diet
Psyllium
Use of Bran

MC area of diverticulitis

-Sigmoid colon (due to high intraluminal pressure)

Symptoms of diverticulitis

LLQ abdominal pain
Low grade fever
Nausea, vomiting
Constipation, Diarrhea
Changes in bowel habits

Diagnostic of choice for diverticulitis

-CT scan (initial)

What is the criteria for admission with diverticulitis?

- Perforation, abscess, obstruction or fistula | - High fever, sepsis, immunocompromised, increased age, unable to tolerate oral intake

Treatment for uncomplicated diverticulitis

- Treat as outpatient with oral antibiotics (Metronidazole + Ciprofloxacin or Levofloxacin) for 7-10 days - Metro + Bactrim (alternative)

What is toxic megacolon?

-Nonobstructive, extreme colon dilation > 6 cm + signs of systemic toxicity

What are some common etiologies of toxic megacolon?

-Complications of IBD, C. diff, radiation, volvulus

Symptoms of toxic megacolon

- Profound bloody diarrhea - Lower abdominal tenderness - Distention - Signs of toxicity: AMS, fever, tachycardia, hypotension, dehydration

What is the initial imaging of choice for toxic megacolon?

Abdominal radiographs

What do the abdominal radiographs for toxic megacolon usually show?

-Radiologic evidence of colon > 6 cm

Treatment for toxic megacolon

Supportive mainstay: bowel rest, bowel decompression with NG tube, Ceftriaxone + Metro, fluid and electrolyte replacement

What is Olgivie Syndrome?

-Colonic pseudo-obstruction (no mechanical obstruction present)

What are some etiologies of olgivie syndrome?

- Postoperative state - Medications (opiates) - Metabolic (hypokalemia, hypercalcemia) - Hypothyroidism - DM

Symptoms of Olgivie Syndrome

- Abdominal distention! | - Tympanitic abdomen

Although abdominal radiographs are the initial test for Olgivie Syndrome, what is the most accurate test?

CT scan

Treatment for Olgivie Syndrome

- Conservative: electrolyte and fluid repletion (if < 12 cm) - Medical decompression: Neostigmine (if > 12 cm or failed 24-48 hours of conservative) - Colonoscopic decompression: if failed conservative and Neostigmine - Surgical decompression: if all other options fail

Name risk factors for IBD

- Jewish population, Caucasians - 15-35 years old - UC in males, Crohn's in females - Smoking bad for Crohn's and protective in UC - Western diet - Medications: NSAIDs, OCP

Name some extra-intestinal manifestations for IBD

- Anterior uveitis/iritis - B12 and iron deficiency - Increased risk of thromboembolism - Arthritis, osteoporosis

Name 8 factors about UC

- Limited to colon, rectum always involved, contiguous spread - Mucosa and submucosa only - LLQ pain, bloody diarrhea - Smoking decreases risk - Uniform inflammation and pseudopolyps (colonoscopy) - Stovepipe sign (barium studies) - no haustral markings - P-ANCA labs - Surgery is curative

Name 8 factors about Crohn's Disease

- Any segment of GI tract, MC in terminal ileum - Transmural - RLQ pain, no bloody diarrhea - Smoking does not decrease risk - Perianal disease (fistulas, abscesses, granulomas) and B12/Fe deficiency common - Skip lesions and cobblestone appearance (Colonoscopy) - String sign (barium studies) - ASCA (labs) - Surgery is noncurative

Initial test of choice for Crohn's Disease and UC

-Upper GI series

Treatment for Crohn's Disease

- Limited ileocolonic disease: 5-ASA (Mesalamine) or oral glucocorticoids - Ileal and proximal: Glucocorticoids (Pred, Budesonide) - Severe: Azathioprine, Methotrexate, Infliximab

What is shown on the following imaging studies for Crohn's Disease? - Upper GI series: - Endoscopy: - Biopsy: - Labs:

- Upper GI series: string sign - Endoscopy: Skip areas, cobbles-toning - Biopsy: Transmural inflammation, noncaseating granulomas - Labs: ASCA, B12 and Iron Deficiency

What is shown on the following diagnostics for UC? - Flexible sigmoidoscopy: - Biopsy: - Barium Enema: - Labs:

- Flexible sigmoidoscopy: uniform erythema and ulceration - Biopsy: crypt abscesses and atrophy, contiguous involvement - Barium Enema: stovepipe or leadpipe sign - Labs: P-ANCA

What are some maintenance therapy options for Crohn's and UC?

- Azathioprine - Methotrexate - Cyclosporine - Tacrolimus - Anti-TNF agents (Infliximab, Adalimumab)

For mild to moderate UC and Crohn's, what is the first-line therapy?

-5-ASA (Mesalamine) Topical | Oral if needed, can be added