GI High Yield HO Flashcards
differential dx for hematochezia
hemorrhoids anal fissures diverticular bleed IBD infectious colitis ischemic colitis AV malformation rapid upper GIB polyps rectal ulcers colorectal cancer radiation colitis
painless bleeding associated with bowel movement, coats the stool at the end of the defecation. blood may also drip into the toilet or stain toilet paper
hemorrhoids
dx from the hx, tearing pain with the passage of bowel movements, a small amount on the toiilet paper or on the surface of stool
anal fissures
which IBD is more likely to present with hematochezia
ulcerative colitis
hematochezia developed weeks to years after abdominal or pelvic irradiation
radiation colitis
what are important history and physical points to ask/perform on a GIB patient
prior episodes of GI bleeding?
pregnancy?
hx of IBD, cancer, CV disease, diverticulosis, PUD
medications - NSAIDS, anticoagulants, antiplatelets
PE - assess hemodynamic stability - look for signs of hypovolemia
general exam - CP, skin, abdominal, DRE
signs of hypovolemia include
mild to moderate hypovolemia will present with resting tachycardia
15% blood volume loss - orthostatic hypotension (decrease in systolic of more than 20 mmhg and/or increase in HR of 20bpm when moving from recumbency to standing)
40% decrease - supine hypotension
medications of interest in GIB patients
NSAIDS
anticoagulants
antiplatelets
ulcerative colitis assocation with smoking
stopping smoking is a risk factor for UC
crohn disease assocaition with smoking
starting smoking can induce flare or first episode
continued smoking leads to a poorer prognosis
bun:cr ratio in upper GIB patients
30:1
ast:alt ratio in an alcoholic
2:1
anatomical division between the upper GI and lower GI
ligament of trietz
pt abruptly stops using a beta blocker – what are they at risk of developing
rebound sinus rhythm
what dx study should be performed in any femal of child-bearing age with abdominal pain?
pregnancy test
fastest rate K can be given in a peripheral IV
10mEq/hour
otherwise it is irritating
how many g/dl would you expect hemoglobin to rise after infusing 1 unit of PRBCs
1 unit should raise Hgb by 1g/dL
primary tx for acute IBD flare up
corticosteroids
IV or PO
red nodular areas on the shins seen in many inflammatory conditions
erythema nodosum
initial management of an acute lower GIB
supportive: IV ccess, appropriate setting (outpatient/inpatient/ICU) O2, IVF, blood products, assessment and management of coagulopathies
in patients with ongoing bleeding or high risk clinical features
colonoscopy w/in 24h
before recieving a colonoscopy, what should be patients be adminsitered
4-6L of PEG
if patient presenting with a subacute GIB has a stable
but low hemoglobin, how should you manage
type and screen
at what hemoglobin level do young patients without cormorbid illness recieve transfusion
< 7 g/dL
at what hemoglobin level do older patients with comorbid illnesses such as CAD require transfusion
<9 g/dL
before transfusing any PRBCs, what lab test should you perform?
iron studies
otherwise they will be inaccurate
pros to radionuclide imaging
noninvasive
sensitive to low rates of bleeding
can be repeated for intermittent bleeding
cons - has to be performed during active bleeding
poor localization of bleeding site
not widely available
pros to CT angiography
noninvasive
accurately localizes bleeding source
provides anatomic detail
widely available
cons - has to be performed during active bleeding
not therapeutic
radation and IV contrast exposure
pros to angiogrpahy
localization
therapy w/ super selective embolization
does not require bowel prep
cons
active bleeding
potential for serious complicatiosn
