Lower GI Bleeding

Question 1

Common symptoms of anemia

Answer 1

weakness, easy fatigability, pallor of conjunctivae/skin, chest pain, dizziness, tachycardia, hypotension,, orthostasis

Question 2

Risk factors for presenting in shock in the setting of lower GI bleed

Answer 2

older patient, comorbidities such as CAD

Question 3

T/F: hematochezia always means lower GI bleed

Answer 3

FALSE. Can also be seen in patients with heavy upper GI bleed

Question 4

How to definitively differeniate between lower and upper bleed

Answer 4

nasogastric aspriate

aspirate that shows bile not blood = lower GI source of bleeding

Question 5

If patient isn’t HDS…

Answer 5

TRANSPORT IMMEDIATELY TO ER.

Question 6

Test of choice for determination of lower GI bleedng source

Answer 6

colonoscopy

Question 7

alternatives to colonoscopy if unavailalbe

Answer 7

angiography, technetium labeled colloid, sigmoidoscopy (if negative -> colonoscopy, then if both negative -> panendoscopy)

Question 8

Most common sources of lower GI bleeding

Answer 8

hemorrhoids > colorectal polyps > diverticulosis > colorectal cancer > ulcerative colitis (UC) > AVM > colonic stricture

Question 9

“internal” vs “external” hemorrhoids

Answer 9

internal =  above dentate line
external = below dentate line

Question 10

Risk factors for hemorrhoids (dilated vessels in anus)

Answer 10

chronic constipation, straining during BM, pregnancy, prolonged sitting (i.e. truck drivers)

Question 11

conservative treatment for hemorrhoids

Answer 11

high fiber diet, stool softeners, precautions against prolonged straining

Question 12

outpouchings of colonic mucosa through weakened areas of colon wall

Answer 12

diverticula

Question 13

why are diverticula so hard to diagnose?

Answer 13

often asymptoatic and must be found on endoscopy/bowel imaging studies…painless bleeding usually

Question 14

Risk factors that increase diverticular bleeding

Answer 14

aspirin or NSAID use

Question 15

how to treat asymptomatic and symptomatic diverticular bleeding

Answer 15

asymptomatic - high fiber diet

symptomatic - may need to resect affected area of colon

Question 16

presentation of diverticulitis

Answer 16

LLQ pain, fever, nausea, diarrhea/constipation

Question 17

complications of diverticulitis

Answer 17

perforation and/or intraabdominal abscess cor pertonitis

Question 18

How to treat diverticulitis

Answer 18

bowel rest plus antibiotics (combo of quinolone and agent for anaerobes like metronidizole)

if perf…SURGERY

Question 19

CONTINUOUS inflammation of large bowel starting from rectum and extending proximally

Answer 19

UC

Question 20

areas of focal inflammation, can occur anywhere in GI tract

Answer 20

crohn’s disease

Question 21

Symptoms of IBD

Answer 21

recurrent episodes of abdominal pain, diarrhea, weight loss, rectal bleeding, fistulas, abscesses

Question 22

Extraintestinal manifestations of IBD

Answer 22

arthritis (most common), sclerosing choloangitis, cirrhosis, fatty liver, pyoderma gangrenosum, erythema nodosum

Question 23

UC is major risk factor for

Answer 23

development of colon cancer

Question 24

Symptomatic therapy for IBD

Answer 24

antidiarrheal meds, immunosppresive meds, anti inflammatory meds

Question 25

Which IBD can be treated definitely with surgery and when to do this?

Answer 25

UC with total colectomy…reserve for pancolitis, failure to respond to medical therapy, or because of colon cancer risk

Question 26

adenmatous polyps

Answer 26

benign growths that have a potential to become malignant

Question 27

list adenomatous polyps in order of potential for becoming cancerous (name three)

Answer 27

tubular adenoma, tubulovillous adenoma, villous adenoma

Question 28

Any patient older than 50 with lower GI bleeding must be evaluated for…

Answer 28

colon cancer

Question 29

when to start screening for colon cancer

Answer 29

age 50 or younger if they have increased risk (family history, UC, hx of polyps)

Question 30

Lower GI bleeding vs upper GI bleeding

Answer 30

lower is distal to ligament of treitz (b/w duodenum and jejunem)