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
pros to colonoscopy
precise dx and therapeutic
endoscopic therapy is possible
cons - need to prep colon - risk of sedation in acutely bleeding patient
definite bleeding source infrequently IDd
patients with UC are at an increased risk for what complications?
toxic megacolon
PSC
ankylosing spondylitis
pyoderma gangrenosum
colon cancer and DVT
pt with crohns are at an increased risk for what complications
fistulas/strictures fissures pigmented gallstone formation malabsorption kidney stones
colon cancer and DVT
grey turner sign and cullen sign are two clinical signs of what event
retroperitoneal hemorrhage
cullen - periumbilical ecchy
grey turner - flank ecchy
people who are in good health, with no risk factors, and with a life expectancy of more than 10 years are recommended to get colorectal cancer screening how often?
beginning at age 45, every 10 years until 75
people ages 76-85 recommendation for colorectal cancer screening
decision to be screening should be based on a persons preferences, life expectancy, overall health and prior screening hx
at what age are patients no longer recommended to get colorectal cancer screening?
over 85
risk factors for colorectal cancer
personal hx of colorectal cancer or certain polyps
family hx of colorectal cancer
personal hx of IBD
confirmed or suspected FAP or lynch
hx of radiation to the abdomen or pelvic area to treat prior cancer
if you have a first degree relative with colorecgtal cancer/adenoma diagnosted before 60 or two first degree relative of any age, when should you start getting screened for colorectal cancer?
40, or 10 years before first diagnosis in relative, whichever is sooner
if you have a first degree relative who had colorectal cancer after the age of 60 or two second degree relatives with colorectal cacner, when should you start getting screened for colorectal cancer?
start at 40
patients at risk of inherited FAP should begin screening at?
sigmoidoscopy at 10-12, with genetic testing
patients at risk of inherited HNCC should begin screening at what age?
20-25 or 10 years younger than youngest age of colorectal cancer dx in family colonoscopy every 2 years
concurrent genetic testing
stool based tests for colorectal cancer screening?
gFOBT
FIT
FIT-DNA
direct visualization tests for colorectal cancer screening?
colonoscopy *****
CT colonoscopy
flexible sigmoidoscopy
flexible sigmoidoscopy with FIT
gold standard for colorectal cancer screening
colonoscopy
crohns or UC: mucosal layer only
UC
crohns or UC: transmural thickness affected
crohns
crohns or UC: affects only the colon
UC
crohns or UC: continuous lesinos
UC
crohns or UC: skip lesions
crohns
crohns or UC: occurs anywhere along the GI tract
crohns
crohns or UC: ASCA positive
crohns
crohns or UC: pANCA positive
UC
crohns or UC: noncaseating granulomas
crohns
crohns or UC: blood diarrhea is common
UC
crohns or UC: crypt abcesses on histology
UC
crohns or UC: strictures and obstructions
crohns
crohns or UC: weight loss, fistulas, peri-anal disease
corhns
crohns or UC: aphthous ulcers
crohns
crohns or UC: pseudopolyps
UC
crohns or UC: toxic megacolon
UC
crohns or UC: creeping fat and cobblestoning
crohns
crohns or UC: smoking is protective
UC
crohns or UC: smoking worses the dz
crohns
prophylaxis for DVT
sequential compression stockings/devices
TED hose
anticoagulation
early ambulation
before starting an immunomodulatory or biologic medication, waht should be checked?
TPMT enzyme activity before azathiopurine
PPD skin test or quantiferon gold to check for TB
viral hepatitis serology
risk factors for AAA
65+
male
hx of smoking
first degree relative with hx of AAA
iv, not hooked up to any infusion, flushed with saline and then locked
saline lock
iv, not hooked up to any infusion, flushed with heparin then locked
heparin lock
hooked up to infusion at slo rate
KVO
maintenance IVF
125cc/hr
rapid rehydration IVF volume
1L bolus
unnaceptable treatment for jehovahs witnesses
transfusion of allogeneic whoel blood, red blood cells, white blood cells, platelets or plasma
preoperative autologous blood donation
