Lower GI Bleeding Flashcards

1
Q

Common symptoms of anemia

A

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

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2
Q

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

A

older patient, comorbidities such as CAD

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3
Q

T/F: hematochezia always means lower GI bleed

A

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

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4
Q

How to definitively differeniate between lower and upper bleed

A

nasogastric aspriate

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

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5
Q

If patient isn’t HDS…

A

TRANSPORT IMMEDIATELY TO ER.

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6
Q

Test of choice for determination of lower GI bleedng source

A

colonoscopy

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7
Q

alternatives to colonoscopy if unavailalbe

A

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

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8
Q

Most common sources of lower GI bleeding

A

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

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9
Q

“internal” vs “external” hemorrhoids

A
internal =  above dentate line
external = below dentate line
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10
Q

Risk factors for hemorrhoids (dilated vessels in anus)

A

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

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11
Q

conservative treatment for hemorrhoids

A

high fiber diet, stool softeners, precautions against prolonged straining

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12
Q

outpouchings of colonic mucosa through weakened areas of colon wall

A

diverticula

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13
Q

why are diverticula so hard to diagnose?

A

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

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14
Q

Risk factors that increase diverticular bleeding

A

aspirin or NSAID use

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15
Q

how to treat asymptomatic and symptomatic diverticular bleeding

A

asymptomatic - high fiber diet

symptomatic - may need to resect affected area of colon

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16
Q

presentation of diverticulitis

A

LLQ pain, fever, nausea, diarrhea/constipation

17
Q

complications of diverticulitis

A

perforation and/or intraabdominal abscess cor pertonitis

18
Q

How to treat diverticulitis

A

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

if perf…SURGERY

19
Q

CONTINUOUS inflammation of large bowel starting from rectum and extending proximally

20
Q

areas of focal inflammation, can occur anywhere in GI tract

A

crohn’s disease

21
Q

Symptoms of IBD

A

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

22
Q

Extraintestinal manifestations of IBD

A

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

23
Q

UC is major risk factor for

A

development of colon cancer

24
Q

Symptomatic therapy for IBD

A

antidiarrheal meds, immunosppresive meds, anti inflammatory meds

25
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
26
adenmatous polyps
benign growths that have a potential to become malignant
27
list adenomatous polyps in order of potential for becoming cancerous (name three)
tubular adenoma, tubulovillous adenoma, villous adenoma
28
Any patient older than 50 with lower GI bleeding must be evaluated for...
colon cancer
29
when to start screening for colon cancer
age 50 or younger if they have increased risk (family history, UC, hx of polyps)
30
Lower GI bleeding vs upper GI bleeding
lower is distal to ligament of treitz (b/w duodenum and jejunem)