GI CIS high yield handout 2 Flashcards
procedures used for evaluation of lower GIB
radionuclide imaging
CT angiography
angiography
colonoscopy
iscehmic colitis
abdominal pain followed by profuse bleeding
poderma gangrenosum
UC
infectious colitis
similar clinical presentation and endoscopic appearance to UC, excluded with stool and tissue culture, stool studies, and on biopsies of colon
ankylosing spondylitis
UC
during an acute IBD flare, what is the primary treatment
corticosteroids
proctitis
insidiously with intermittent rectal bleeding, passage of mucus, and mild diarrhea associated with fewer than four small loose stools per day
initial managment of acute lower GIB in pts with ongoing bleeding or high-risk clinical features
colonscopy witin 24 hours presentation after colon prep to improve diagnositc and therapeutic yield
-adeqyete bowel prep need 4-6 liters of polyethylene glycol
NG tube may help with getting prep down
pigmented gallstone formation
CD
pts with active bleeding and hypovolemia may require what
blood tranfusion despite apparently normal hemoglobin
what is the Bun:Cr ration in an upper GIB
30:1
colon cancer
CD and UC
rectal ulcers can present with
bleeding, passage of mucus, straining during defecation, and a sense of incomplete evacuation
malabsorption
CD
ad and disad of CT angiography for lower GIB
ad: noninvasive, localize bleeding source, provides anatomic detail, widely available
disad: has to be performed during active bleeding
not therapeutic, radiation and IV contrast exposure
young pts without comorbid illness may not require tranfusion until hemoglobin is
less than 7 g/dL
what is the AST:ALT ratio in an alcoholic
2:!
what can abruptly stopping a beta blocker lead to
rebound tachy
when do you obtain iron studies
before transfusion bc afterwards they are inaccurate
older pts and those who have severe comorbid illnesses like CAD require at least
9 g/dL
how fast can postassium chloride be given through a peripheral IV
10 mEq per hour
angiography advant and disadvant for lower GIB
ad: localize bleeding source, therapy possible, no bowel prep
disad: has to be done during active bleed, potential for serious complications
tearing pain with the passage of bowel movements, a small amount on the toilet paper or on the surface of stool
anal fissures
DVT
CD and UC
painless profuse bleeding
diverticular bleed
what diagnositcs should be condsidered when there is concern for upper GI bleeding source
high index
mod suspicion
high index suspicion–> upper endoscopy EGD
moderate suspicion–> NG tube with lavage
what is the anatomical division of an upper GIB vs lower GIB
ligament of Treitz
consideration for blood transfusion with packed RBC’s
type and screen if hemoglobin is stable and no acute bleed
type and cross
initial management of acute lower GI bleed
supportive: IV access, O2, blood products, assessment and managment of coagulopathies
how many g/dL would you expect the hemoglobin to raise from 1 unit of packed RBCs
giving 1 unit of PRBC’s should incresae Hgb by 1g/dL
signs of hypovolemia
mild to moderate hypovolemia: resting tachy
blood volume loss of at least 15 percetn: ortostatic hypotension
blood volume loss of at least 40%: supine hypotension
advantage and disadvantage radionuclide imaging for lower GIB
ad: noninvasive, detects low rate bleeding and can be repeated for intermittent bleeding
disad: has to be performed during active bleeding, poor locatlization, not therapeutic
colnocscopy for lower GIB disad and advant
ad: precise diagnosis and locatliztion, endoscopic therapy possible
disad: need colon prep, risk of sedation in acutely bleeding pt, definite bleeding source infreq identified
positive UGIB
false neg when
coffee ground material or bright red blood
can be false negative if bleeding stopped or its beyond a closed pylorus (duod bleed)
