GI CIS Flashcards
Describe type of bleeding associated with hemorrhoids
Painless bleeding, usually associated with BM, coats the stool at end of defecation. Blood may drip into toilet or stain toilet paper
Describe type of bleeding associated with anal fissures
Small amount on toilet paper or surface of stool; usually dx on history of tearing pain with passage of BM
Describe type of bleeding associated with diverticula
Painless, profuse bleeding
Which is more likely to exhibit hematochezia — UC or crohns?
UC
Describe presentation of infectious colitis
Similar clinical presentation and endoscopic appearance of UC; excluded with stool and tissue cultures, stool studies, and on biopsies of the colon (EHEC)
What condition may present as abdominal pain followed by profuse hematochezia?
Ischemic colitis
T/F: polyps are typically symptomatic and result in intermittent large amounts of bleeding
False, they are typically asymptomatic and most often detected by colon cancer screening tests as occult bleeding
Describe type of bleeding associated with proctitis
Insidiously with intermittent rectal bleeding, passage of mucus, and mild diarrhea associated with fewer than 4 small loose stools per day (like mild UC)
Describe type of bleeding associated with rectal ulcers
Can present with bleeding, passage of mucus, straining during defecation, and sense of incomplete evacuation
Important hx and PE points to ask/perform on GIB patient
Prior episodes of GI bleeding?
Chance of pregnancy in females
PMH of IBD, cancer, CV dz, diverticulosis, PUD
Medications — ask about NSAIDs, ACs, antiplatelet agents
PE: assess hemodynamic stability, general exam, CV, skin, abdominal, DRE
How is smoking related to IBD?
Stopping smoking is risk factor for UC
Starting smoking is risk factor for Crohns, continued smoking = poorer prognosis
BUN:Cr ratio seen in upper GIB
30:1
AST:ALT ratio in alcoholic
2:1
Anatomical division of an upper GIB vs lower GIB
Ligament of Treitz
Recognize what abruptly stopping a beta blocker can lead to
Rebound sinus tachycardia
How fast can KCl be given through a peripheral IV?
10 mEq/hr (otherwise it is irritating the vein)
How many g/dL would you expect the Hgb to rise from 1 unit of PRBCs?
1g/dL
Primary tx for acute IBD flare
Corticosteroids (IV or PO)
Condition often seen with IBD characterized by red nodular areas on shins
Erythema nodosum
Initial management of acute lower GIB
Supportive: IV access, admit to appropriate setting, O2, IVF, blood products, assessment/management of coagulopathies
In cases of ongoing bleeding or high risk features: colonoscopy should be done w/i 24 hours of presentation after adequate colon prep (typically 4-6 L polyethylene glycol — may require NG tube)
Considerations for blood transfusion with PRBCs (type and screen vs. type and cross), what are Hgb requirements of special pt populations?
First type and screen in Hgb is stable and no acute bleed
Type and cross for young pts without comorbidities (may not require transfusion until Hgb <7), older pts who have severe comorbid conditions like CAD require Hgb of >9
Obtain iron studies if desired BEFORE transfusion, otherwise inaccurate
T/F: pts with active bleeding and hypovolemia may require transfusion even if they have a normal Hgb
True
Diagnostic test for GIB that is noninvasive, sensitive to low rates of bleeding, and can be repeated for intermittent bleeding, BUT it has to be performed during active bleed, has poor localization, not therapeutic, and not widely available
Radionuclide imaging
Diagnostic test for GIB that is noninvasive, accurately localizes bleeding source, provides anatomic detail, and is widely available; BUT it has to be performed during active bleeding, is not therapeutic, and may require IV contrast+radiation exposure
CT angiography
