Lower GIB Flashcards
Lower GI bleed involves a source where?
Distal to Ligament of Treitz
Most common sign of a LGIB?
Hematochezia = bright red blood in stool
Differential diagnoses of LGIB depend on what 2 things?
Age of patient
Severity of bleeding
What things can stimulate Hematochezia?
NSAIDs, Anticoagulants, liquid medication with red dye
Beets, Red Kool-aid
Co-morbid conditions?
IBD
Liver/renal/diverticular disease
10% of hematochezia conditions are due to what type of bleed?
UPPER GI bleed
90% of hematochezia conditions are due to what type of bleed?
Lower GI bleed
4 common differential diagnoses for a LGIB?
Diverticulosis
IBD
Ischemic Colitis
Intussusception
4 common differential diagnoses for a LGIB?
Diverticulosis
IBD
Ischemic Colitis
Intussusception
Diverticulosis
Sac-like protrusions of mucosa through the muscularis due to increased intraluminal pressure
Most common location for Diverticulosis?
Sigmoid colon
Symptoms of Diverticulosis?
PAINLESS, large-volume hematochezia in older patients
Many patients with Diverticulosis describe have ____ history with colonoscopy
Normal
– usually asymptomatic
Diagnostic test to do for Diverticulosis once the bleeding stops?
Colonoscopy
Diverticulitis vs. Diverticulosis?
Diverticulitis = NO hemorrhage Diverticulosis = Large volume Hematochezia (painless)
Painless hematochezia in elderly patients with an asymptomatic history could be?
Diverticulosis
2 types of IBD?
Crohn Disease
Ulcerative Colitis
Crohn Disease - correlation with smoking?
Usually onset of Crohn’s correlates with new onset of cigarette smoking
Symptoms of Crohn Disease?
Fever, RLQ pain (mimics appendicitis), diarrhea
Why does Crohn Disease present with RLQ pain?
Ileum is most commonly affected (ileitis)
Abscesses, strictures, fistulas are all common with?
Crohn Disease
For Crohn Disease, serum ___ will be (+)
ASCA
What sign will be (+) with enema for Crohn Disease?
String sign - due to narrowing of lumen
Possible complications with Crohn Disease?
Colon cancer
Gall/kidney stones
Bile salt malabsorption - secretory diarrhea
Is surgery suggested for Crohn Disease?
ONLY if absolutely necessary for complications
– can make Crohn Disease worse!
Is perinanal disease common with Crohn Disease?
Yes
Ulcerative Colitis - correlation with smoking?
Can correlate with recent cessation of smoking
- smoking is protective against developing it
Symptoms of Ulcerative Colitis?
Bloody diarrhea, fecal urgency and cramps relieved by defecation
- LLQ pain
Bloody diarrhea with cramps that are relieved by defecation can suggest?
Ulcerative Colitis
For Ulcerative Colitis, serum ___ will be (+)
ANCA
ANCA (+)
Ulcerative Colitis
ASCA (+)
Crohn Disease
What sign will be positive with Ulcerative Colitis?
“lead pipe colon” = loss of haustra
Possible complications of Ulcerative Colitis?
Colon cancer
Toxic megacolon, sclerosing cholangitis
Is surgery suggested for Ulcerative Colitis?
Yes - not first line of treatment though
2 common extra-intestinal manifestations of Ulcerative Colitis?
Pyoderma gangrenosum
Ankylosing spondylitis
Pyoderma gangrenosum and ankylosing spondylitis can be seen with?
Ulcerative Colitis
Common PMH item with Ischemic Colitis?
Atherosclerosis
Symptoms of Ischemic Colitis?
Cramping lower abdominal pain and passage of bloody stool
What does the X-ray show with Ischemic Colitis and why?
Thumb-printing
- hemorrhage causes colonic wall thickening
What does a Sigmoidoscopy show with Ischemic Colitis?
Friability and submucosal hemorrhage
- risk of perforation due to free air under diaphragm
Telescoping bowel
Intussusception
What will be seen on imaging with Intussusception?
Bull’s eye
Symptoms of Intussusception?
Common in kids
= Colicky abdominal pain
- - jelly like stool?
Symptoms of Intussusception?
Common in kids
= Colicky abdominal pain
- - jelly like stool?
