Lower GI Bleeding Flashcards
Common symptoms of anemia
weakness, easy fatigability, pallor of conjunctivae/skin, chest pain, dizziness, tachycardia, hypotension,, orthostasis
Risk factors for presenting in shock in the setting of lower GI bleed
older patient, comorbidities such as CAD
T/F: hematochezia always means lower GI bleed
FALSE. Can also be seen in patients with heavy upper GI bleed
How to definitively differeniate between lower and upper bleed
nasogastric aspriate
aspirate that shows bile not blood = lower GI source of bleeding
If patient isn’t HDS…
TRANSPORT IMMEDIATELY TO ER.
Test of choice for determination of lower GI bleedng source
colonoscopy
alternatives to colonoscopy if unavailalbe
angiography, technetium labeled colloid, sigmoidoscopy (if negative -> colonoscopy, then if both negative -> panendoscopy)
Most common sources of lower GI bleeding
hemorrhoids > colorectal polyps > diverticulosis > colorectal cancer > ulcerative colitis (UC) > AVM > colonic stricture
“internal” vs “external” hemorrhoids
internal = above dentate line external = below dentate line
Risk factors for hemorrhoids (dilated vessels in anus)
chronic constipation, straining during BM, pregnancy, prolonged sitting (i.e. truck drivers)
conservative treatment for hemorrhoids
high fiber diet, stool softeners, precautions against prolonged straining
outpouchings of colonic mucosa through weakened areas of colon wall
diverticula
why are diverticula so hard to diagnose?
often asymptoatic and must be found on endoscopy/bowel imaging studies…painless bleeding usually
Risk factors that increase diverticular bleeding
aspirin or NSAID use
how to treat asymptomatic and symptomatic diverticular bleeding
asymptomatic - high fiber diet
symptomatic - may need to resect affected area of colon
presentation of diverticulitis
LLQ pain, fever, nausea, diarrhea/constipation
complications of diverticulitis
perforation and/or intraabdominal abscess cor pertonitis
How to treat diverticulitis
bowel rest plus antibiotics (combo of quinolone and agent for anaerobes like metronidizole)
if perf…SURGERY
CONTINUOUS inflammation of large bowel starting from rectum and extending proximally
UC
areas of focal inflammation, can occur anywhere in GI tract
crohn’s disease
Symptoms of IBD
recurrent episodes of abdominal pain, diarrhea, weight loss, rectal bleeding, fistulas, abscesses
Extraintestinal manifestations of IBD
arthritis (most common), sclerosing choloangitis, cirrhosis, fatty liver, pyoderma gangrenosum, erythema nodosum
UC is major risk factor for
development of colon cancer
Symptomatic therapy for IBD
antidiarrheal meds, immunosppresive meds, anti inflammatory meds
Which IBD can be treated definitely with surgery and when to do this?
UC with total colectomy…reserve for pancolitis, failure to respond to medical therapy, or because of colon cancer risk
adenmatous polyps
benign growths that have a potential to become malignant
list adenomatous polyps in order of potential for becoming cancerous (name three)
tubular adenoma, tubulovillous adenoma, villous adenoma
Any patient older than 50 with lower GI bleeding must be evaluated for…
colon cancer
when to start screening for colon cancer
age 50 or younger if they have increased risk (family history, UC, hx of polyps)
Lower GI bleeding vs upper GI bleeding
lower is distal to ligament of treitz (b/w duodenum and jejunem)
