GI day 2 part 2

Question 1

Similar to chicken pox

Answer 1

CMV colitis

Question 2

CMV colitis

transmission

Answer 2

Transmitted through cough droplets, saliva, tears, sex

Question 3

Most adults have virus on normal flora

Answer 3

CMV colitis

Question 4

CMV colitis

can cause this

Answer 4

Can cause colitis, enteritis, retinitis, esophagitis, hepatitis in immunosuppressed

Question 5

MCC viral diarrhea

Answer 5

CMV colitis

Question 6

MCC of emergency laparotomy in AIDS

Answer 6

CMV colitis

Question 7

CMV colitis

sx

Answer 7

Bloody diarrhea, fever, weight loss

Question 8

CMV colitis

dx

Answer 8

Endoscopy- mucosal ulcers, submucosal hemorrhages

Biopsy- cytoplasmic CMV inclusion bodies and inflammation

Question 9

CMV colitis

trmt

Answer 9

1. Ganciclovir
2. Cidofovir
3. Foscarnet
   Surgery if massive hemorrhage, perforation, or toxic megacolon

Question 10

MC ischemic injury to the gut

Answer 10

Ischemic colitis

Question 11

Focal and non-occlusive

Answer 11

Ischemic colitis

Question 12

where is Ischemic colitis mc in the body

Answer 12

“Watershed” areas- splenic flexure and sigmoid colon

Question 13

2 vulnerable regions in Ischemic colitis

Answer 13

Griffith’s point at splenic flexure and Sudeck’s point at sigmoid colon

Question 14

griffiths point?

Answer 14

Griffith’s point at splenic flexure- junction at lateral branch of mic colic (SMA) and asc branch of left colic (IMA)

Question 15

sudecks point?

Answer 15

Sudeck’s point at sigmoid colon- junction of sigmoid branch (IMA) and hypogastrics

Question 16

Long distance running is a predisposing factor of this

Answer 16

Ischemic colitis

Question 17

Ischemic colitis

severity

Answer 17

Duration of decrease in blood flow, how much the vessel is occluded, onset of ischemia, metabolic requirements of affected bowel, colonic distension, collateral circulation virulence of bacteria

Question 18

ischemic colitis classification

Answer 18

Transient ischemia- MC
Ischemic stricture
Gangrenous

Question 19

Transient ischemia?

Answer 19

Reversible
Heals with a scar but no long term problems
Mucosal edema, congestion, superficial ulcers and petechiae

Question 20

in Transient ischemia what is seen on plain film?

Answer 20

“Thumbprinting”- submucosal hemorrhage seen on plain film

Question 21

endoscopy of ischemic stricture

Answer 21

narrowing of lumen

Question 22

radiograph of ischemic stricture

Answer 22

proximal dilation of bowel

Question 23

trmt ischemic stricture

Answer 23

endoscopic balloon dilation

Question 24

Ischemic stricture?

Answer 24

.Partial thickness injury of mucosa and muscular layer → fibrosis and lumen narrowing

Question 25

Gangrenous ischemic colitis?

Answer 25

Full thickness necrosis | Patchy or confluent

Question 26

dont do this in gangrenous ischemic colitis

Answer 26

contrast studies

Question 27

Gangrenous ischemic colitis | trmt

Answer 27

Immediate surgery

Question 28

Ischemic colitis | sx

Answer 28

Sudden onset Crampy abd pain in LLQ Bloody diarrhea +/- mucus Fever, bloating, urge to poop, syncope

Question 29

Ischemic colitis | pe

Answer 29

``` Mild distension Tenderness in LLQ Frank or occult blood in rectal exam Sepsis Shock ```

Question 30

Ischemic colitis | dx

Answer 30

``` leukocytosis/anemia Plain film- distension, thickened wall, thumbprinting, free air, pneumatosis, portal venous gas CT- nonspecific bowel thickening High serum lactate- nonviable bowel Colonoscopy- best dx test ```

Question 31

Ischemic colitis | trmt

Answer 31

``` Outpatient if mild Hospital if severe ATB if bacterial infection anywhere Stop NSAIDS Surgery if severe ```

Question 32

Early dx and intervention is key

Answer 32

Ischemic colitis

Question 33

Microscopic colitis?

Answer 33

Watery diarrhea with all other tests normal | Mostly women

Question 34

Microscopic colitis | cause

Answer 34

unknown

Question 35

Microscopic colitis | types

Answer 35

Collagenous colitis Lymphocytic colitis Doesn’t convert from collagenous colitis to lymphocytic colitis or vise versa

Question 36

Microscopic colitis | sx

Answer 36

Watery diarrhea- 8 to 30 stools a day Secretory diarrhea- large volumes that don't go away even with fasting Diarrhea isn't bad enough to cause dehydration Colicky abd pain, NV, weight loss, fecal incontinence

Question 37

Collagenous colitis?

Answer 37

Subepithelial collagen layer with eosinophils below surface epithelium Collagen band varies in thickness- doesn't tell disease severity Mild-chronic inflammation in lamina propria

Question 38

Lymphocytic colitis?

Answer 38

Lymphocytic infiltration in lamina propria | No collagen band

Question 39

trmt Microscopic colitis

Answer 39

``` Stop anything that may cause diarrhea Stop NSAIDS 1st line Loperamide or diphenoxylate 2nd line bismuth subsalicylate Steroids are effective but pts relapse when d/c ```

Question 40

Acute lower GI bleeding?

Answer 40

Bleeding distal to ligament of Treitz Life threatening bleeding Need 3-6 units of PRBC (packet red blood cell) Hemoglobin less than 10 gms %

Question 41

Acute lower GI bleeding | sx

Answer 41

Rectal bleeding, cramps, tachycardia/hypotension, pallor, weakness/syncope

Question 42

MCC massive GI bleed is

Answer 42

PUD

Question 43

AV malformation?

Answer 43

Valvular ectasias (dilation) from aging

Question 44

AV malformationdx

Answer 44

Dilated submucosal veins on colonoscopy Spider like appearance Usually in right colon Mesenteric angiogram- early filling vein in arterial phase bc arteries are bypassed

Question 45

Spider like appearance

Answer 45

AV malformation

Question 46

AV malformation usually occurs here

Answer 46

Usually in right colon

Question 47

Most diverticula are in ____

Answer 47

sigmoid colon

Question 48

Diverticular bleeding | dx

Answer 48

Must see active bleeding from diverticulum or have angiographic evidence of bleeding

Question 49

Most ppl with diverticulitis do/don't bleed

Answer 49

dont

Question 50

inflammed/noninflammed diverticula bleed

Answer 50

noninflammed

Question 51

mc site of ischemic colitis

Answer 51

Griffith's point

Question 52

Post polypectomy bleeding?

Answer 52

Polyps seen on routine colonoscopy. We remove polyps and they start bleeding

Question 53

AV malformation trmt

Answer 53

No trmt when discovered incidentally Argon plasma photocoagulation if bleeding Arterial vasopressin or arterial embolization

Question 54

2nd mc site of ischemic colitis

Answer 54

sudecks point

Question 55

in Post polypectomy bleeding | ____ doesnt matter

Answer 55

size

Question 56

Post polypectomy bleeding | cause

Answer 56

ASA

Question 57

Post polypectomy bleeding dx

Answer 57

Colonoscopy | Bleeding scan and CT angiogram- done to make sure they aren't bleeding from another site

Question 58

Post polypectomy bleeding trmt

Answer 58

Inject EPI around bleeding site | Observe pt overnight and watch for bleeding

Question 59

pedunculated polypectomy trmt

Answer 59

sites are easier to deal with Use clip to stop bleeding Monitor pt overnight and watch for rebleeding

Question 60

massive bleeding rare

Answer 60

colonic carcinoma