GI Case 2

Question 1

what is hematochezia?

Answer 1

passage of fresh blood per rectum

Question 2

What are some DDX for hemotochezia

Answer 2

• hamorrhoids
• Anal fissure
• DIverticular bleed
• IBD
• Infectious colitis
• Ischemic colitis
• AV malformation
• Polyps

Question 3

what are the signs of hypovolemia?

Answer 3

• Mild to moderate hypovolemia: resting tachycardia
• blood loss of at least 15% = orthostatic hypotension (dec in systolic BP of more than 20mmHg and/or increase in HR of 20
• Blood loss of 40% = supine hypotension

Question 4

How is smoking related to UC?

Answer 4

stopping is a risk factor for developing UC

Question 5

What is the BUN:Cr ratio in an upper GI bleed?

Answer 5

30:1

Question 6

What is the AST:ALT ratio in an alcoholic?

Answer 6

2:1

Question 7

What is the anatomical division of upper Gi bleed vs lower GI bleed

Answer 7

ligament of Treitz

Question 8

what are some diagnostic options for a pt with lower GI bleed

Answer 8

1. radionuclide imaging (noninvasive and sensitive to low rates of bleeding, performed during active bleeding, poor localization of bleeding site)
2. CT angiograph (noninvasive, performed during active bleed)
3. Angiography (accurate localization, therapy possible, performed during active bleed, risk of serious complication)
4. Colonoscopy ( precise diagnosis, requires time due to bowel prep)

Question 9

what diagnostics are considered when there is a upper GI bleed?

Answer 9

High suspicion –> upper endoscopy (EGD)
Moderate suspicion –> NG tube with lavage (positive UGIB = coffee ground material or bright red blood; negative = billous

Question 10

what is the initial management of an acute lower GI bleed

Answer 10

supportive: IV access, appropriate setting, O2, IVF, blood products, assessment and management of coagulopathies

In pts with ongoing bleeding or high risk clinical features: colonoscopy within24 hrs

Question 11

What are potential complications/risks in pts with IBD?

Answer 11

UC: toxic megacolon, primary sclerosing cholangitis, ankylosing spondylitis, pyoderma gangrenosum

CD: Fistulas/strictures, fissures, pigmented gallstone formation, malabsorption

Both: Colon cancer, DVT

Question 12

How fast can KCl be given through a peripheral IV?

Answer 12

10mEq/hr

Question 13

How many g/dL would you expect the Hg to rise from 1 units packed RBC?

Answer 13

Giving 1 unit of PRBCs should increase Hgb by 1g/dL

Question 14

during an acute IBD flare, what is the primary treatment

Answer 14

corticosteroids (IV or PO)

Question 15

who should be tested/screened for colorectal cancer/

Answer 15

Those with symptoms of colorectal cancer (CRC) –> perform diagnostic studies

Those with no symptoms but at average risk and over 50 should have colonscopy q10yrs, or CTC q5yrs; or FIT annually

Those with increased risk and family hx: genetic testing and early intense screening. Family hx of FDR <60 with CRC or adenoma–>colonscopy starting age 40

Question 16

what are some stool based tests for CRC screening?

Answer 16

• gFOBT yearly
• FIT yearly
• FIT-DNA q1-2yrs

Question 17

what is the gold standard direct visualization test for CRC screening

Answer 17

colonscopy