GI bleeding and IBD

Question 0

How much does one unit pRBCs increase Hgb and Hct

Answer 0

Hgb: 1 g/dl
Hct: 3-4 units

Question 1

Upper vs. lower GI bleeding history and exam

Answer 1

Upper: hematemesis with coffee ground emesis, melena, hypovolemia (tachycardia, lightheadedness, hypotension)

Lower: hematochezia (red blood) more so than melena

Question 2

Ulcerative colitis colonoscopy findings

Answer 2

Diffuse and continuous rectal involvement, firability, edema, and pseudopolyps

Question 3

Crohn’s disease colonscopy findings

Answer 3

Apthoid, linear, or stellate ulcers; strictures; cobblestoning; and skip lesions
Creeping fat may be present during laparotomy

Question 4

What layers of the bowel are involved in UC vs. Crohns?

Answer 4

UC: mucosa and submucosa
Crohns: transmural inflammation -> can lead to fistulas

Question 5

Periana fissures, tags, fistulas are present in what disease?

Answer 5

Crohns disease

Question 6

Extraintestinal manifestations of ulcerative colitis

Answer 6

Primary sclerosing cholangitis
Arthritis
Uveitis
Erythema nodosum
Pydoerma gangrenosum
Apthous stomatitis

Question 7

Treatment of UC and Crohns

Answer 7

UC:

• 5-ASA agents (topical or oral) ie sulfasalazine or mesalamine
• corticosteroids
• immunomodulators (azathioprine)
• total proctocolectomy can be curative for fulminant colitis, toxic megacolon, and to decrease cancer risk

Crohn’s disease

• 5-ASA agents; if that doesn’t help, give steroids and immunomodulators like azathioprine
• surgical resection may be necessary for suspected perforation, stricture, fistula, or abscess

Question 8

Hesselbach’s triangle

Answer 8

Inguinal ligament, inferior epigastric artery, and rectus abdominin

Question 9

Indirect inguinal hernia

-definition, etiology, where it protrudes

Answer 9

Herniation of abdominal contents through the internal and external inguinal ligaments
Most common hernia
2/2 congenital patent processus vaginalis
Protrudes lateral to the inferior epigastric vessels

Question 10

Direct inguinal hernia

-definition, etiology, where it protrudes

Answer 10

Herniation of abdominal contents through the floor of Hesselbach’s triangle
Etiology: acquired defect in transversalis fascia from mechanical breakdown
Protrudes: medial to the epigastric vessels

Question 11

Lead pipe barium swallow

Answer 11

Ulcerative colitis: because all the haustra are gone 2/2 mucosal derangement