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clin med > GI day 2 part 2 > Flashcards

GI day 2 part 2 Flashcards

1
Q

Similar to chicken pox

A

CMV colitis

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2
Q

CMV colitis

transmission

A

Transmitted through cough droplets, saliva, tears, sex

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3
Q

Most adults have virus on normal flora

A

CMV colitis

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4
Q

CMV colitis

can cause this

A

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

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5
Q

MCC viral diarrhea

A

CMV colitis

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6
Q

MCC of emergency laparotomy in AIDS

A

CMV colitis

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7
Q

CMV colitis

sx

A

Bloody diarrhea, fever, weight loss

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8
Q

CMV colitis

dx

A

Endoscopy- mucosal ulcers, submucosal hemorrhages

Biopsy- cytoplasmic CMV inclusion bodies and inflammation

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9
Q

CMV colitis

trmt

A
  1. Ganciclovir
  2. Cidofovir
  3. Foscarnet
    Surgery if massive hemorrhage, perforation, or toxic megacolon
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10
Q

MC ischemic injury to the gut

A

Ischemic colitis

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11
Q

Focal and non-occlusive

A

Ischemic colitis

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12
Q

where is Ischemic colitis mc in the body

A

“Watershed” areas- splenic flexure and sigmoid colon

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13
Q

2 vulnerable regions in Ischemic colitis

A

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

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14
Q

griffiths point?

A

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

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15
Q

sudecks point?

A

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

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16
Q

Long distance running is a predisposing factor of this

A

Ischemic colitis

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17
Q

Ischemic colitis

severity

A

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

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18
Q

ischemic colitis classification

A

Transient ischemia- MC
Ischemic stricture
Gangrenous

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19
Q

Transient ischemia?

A

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

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20
Q

in Transient ischemia what is seen on plain film?

A

“Thumbprinting”- submucosal hemorrhage seen on plain film

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21
Q

endoscopy of ischemic stricture

A

narrowing of lumen

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22
Q

radiograph of ischemic stricture

A

proximal dilation of bowel

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23
Q

trmt ischemic stricture

A

endoscopic balloon dilation

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24
Q

Ischemic stricture?

A

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

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25
Q

Gangrenous ischemic colitis?

A

Full thickness necrosis

Patchy or confluent

26
Q

dont do this in gangrenous ischemic colitis

A

contrast studies

27
Q

Gangrenous ischemic colitis

trmt

A

Immediate surgery

28
Q

Ischemic colitis

sx

A

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

29
Q

Ischemic colitis

pe

A 
Mild distension
Tenderness in LLQ
Frank or occult blood in rectal exam
Sepsis
Shock
30
Q

Ischemic colitis

dx

A 
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
31
Q

Ischemic colitis

trmt

A 
Outpatient if mild
Hospital if severe
ATB if bacterial infection anywhere
Stop NSAIDS
Surgery if severe
32
Q

Early dx and intervention is key

A

Ischemic colitis

33
Q

Microscopic colitis?

A

Watery diarrhea with all other tests normal

Mostly women

34
Q

Microscopic colitis

cause

A

unknown

35
Q

Microscopic colitis

types

A

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

36
Q

Microscopic colitis

sx

A

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

37
Q

Collagenous colitis?

A

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

38
Q

Lymphocytic colitis?

A

Lymphocytic infiltration in lamina propria

No collagen band

39
Q

trmt Microscopic colitis

A 
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
40
Q

Acute lower GI bleeding?

A

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

41
Q

Acute lower GI bleeding

sx

A

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

42
Q

MCC massive GI bleed is

A

PUD

43
Q

AV malformation?

A

Valvular ectasias (dilation) from aging

44
Q

AV malformationdx

A

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

45
Q

Spider like appearance

A

AV malformation

46
Q

AV malformation usually occurs here

A

Usually in right colon

47
Q

Most diverticula are in ____

A

sigmoid colon

48
Q

Diverticular bleeding

dx

A

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

49
Q

Most ppl with diverticulitis do/don’t bleed

A

dont

50
Q

inflammed/noninflammed diverticula bleed

A

noninflammed

51
Q

mc site of ischemic colitis

A

Griffith’s point

52
Q

Post polypectomy bleeding?

A

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

53
Q

AV malformation trmt

A

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

54
Q

2nd mc site of ischemic colitis

A

sudecks point

55
Q

in Post polypectomy bleeding

____ doesnt matter

A

size

56
Q

Post polypectomy bleeding

cause

A

ASA

57
Q

Post polypectomy bleeding dx

A

Colonoscopy

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

58
Q

Post polypectomy bleeding trmt

A

Inject EPI around bleeding site

Observe pt overnight and watch for bleeding

59
Q

pedunculated polypectomy trmt

A

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

60
Q

massive bleeding rare

A

colonic carcinoma

clin med (35 decks)

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