Lower GI Bleed -Jenkins Flashcards
What are the 2 complications of diverticulosis?
bleeding and diverticulitis
if no pain with bleeding =diverticulOSIS (not -itis)
What is the typical presentation of ischemic colitis?
painful and bloody diarrhea in an old person (90yo) with previous cardiac problems
What kind of upper GI bleed an cause bright red rectal bleeding?
esophageal varices that is bleeding a lot –> fast–> bright red
What is a capsule endoscopy good for?
small intestine diseases
not normally for GI bleed
A 53 year old man presents to your gastroenterology office due to a referral from the family doctor for a positive FOBT. He very rarely notes bright red blood on the tissue paper when he is wiping. He does not note any pain. He denies constipation and diarrhea. His stools have been of normal consistency and size. He has not had a colonoscopy yet. What is the proper next step in management?
colonoscopy
what percentage of people with diverticulosis are asymptomatic? What will a pt with diverticulosis bleeding typically present with?
80%
(he said all people > 65 yo have this)
abrupt onset of painless bleeding (can be associated with cramping/urge to defecate and bloating)
What is diverticulosis? Where is most diverticulosis bleeding found?
diverticulosis is an anatomical out-pouching through the colonic wall (common in sigmoid)
smaller radius of the sigmoid colon = higher pressure –> common vessel penetration
You have a 38 year old obese female present to your clinic because she has had rectal bleeding for a month. She has a long standing history of constipation. She states that she often spends 45 minutes straining every day because of her constipation. She denies abdominal pain. She is not on any medication. What is the most likely cause of her bleeding?
diverticulosis
tx=FIBER!
What is the difference in presentation of internal vs external hemorrhoids?
internal=dilated veins of the superior rectal plexus, proximal to the dentate line=less painful, with bleeding
external =dilated veins of the inferior hemorrhoidal plexus distal to the dentate line=painful and not much bleeding
What are the causes of thumb printing?
colitis
on barium enema
What are the differentials for lower GI bleed?
- Diverticulosis-Acute, severe, painless bleeding in the setting of known or suspected diverticular disease
- Angiodysplasia-Recurrent, painless bleeding episodes; can be chronic, leading to iron deficiency anemia
- Ischemic colitis-Self-limited, bloody diarrhea followed by acute lower abdominal pain in patients with cardiac risk factors
- Hemorrhoids- Blood on paper, hemodynamically stable, managed as outpatient ( pain=external, no pain=internal)
- Anal Fissures
- Colon Cancer/ Polyps- Slow, chronic blood loss with change in bowel habit or iron deficiency anemia
- Colitis ( ulcerative, radiation, infectious)=diarrhea
What is the preferred method of diagnosis of diverticulosis? Is this the same for diverticulitis?
barium enema/colonoscopy
*do NOT do on diverticulitis –> can perforate colon
How are most diverticulosis cases treated?
Most stop bleeding on own in 24-48 hours
FIBER
can treat with endoscopic clips, cautery or epinephrine or angiography
pts with persistent lower GI bleeding might need surgery
What are the indications for surgical intervention in diverticulosis bleeding? What is the preferred surgical treatment and what does it require?
large transfusion requirements
recurrent hemorrhage that is refractory
hemodynamic instability that does not respond to medical therapy
-preferred treatment=hemicolectomy —> requires localization of hemorrhage
What is the most common vascular abnormality of the GI tract?
Angiodysplasia =tortuous veins in the colonic submucosa
seen in old people
low grade bleeding that normally stops spontaneously
How do Crohn’s Disease and Ulcerative Colitis cause GI bleeding?
autoimmune processes–> erosion of the wall–> expose vasculature and bleeding
Crohn’s =skip lesions
What are colonic polyps?
are either hyperplastic or neoplastic masses which can be found in the colon
painless bleeding
What is Ischemic colitis? What areas are normally affected? What are some causes?
Inflammation of the colon secondary to ischemia
affects the “watershed” areas of the colon that have limited collateralization (splenic flexure and rectosigmoid junction)
causes: A. fib, CHF, estrogen/OC use, valvular heart disease
In what patient population is Meckel’s diverticulum seen?
Rule of 2’s
- symptoms at 2 yo
- 2% of the population
- only 2% of those have clinical problems
- 2 feet proximal to ileocecal valve (in small intestine) and is 2 inches long
congenital
How should Meckel’s Diverticulum be diagnosed?
Technetium 99m Pertechnetate scan
What is the management for a GI bleed?
- keep the pt alive
- 2 large bore IVs for transfusion if necessary
- diagnose condition -figure out where the bleeding is coming from
