lower GIT hge Flashcards
what is considered upper GI bleeding ?
intraluminal blood loss from a source distal to the treitz ligament
where is the treitz ligament ?
at the duodenojejunal flexure
3rd part of the duodenum
what do we consider as massive LGIB ?
patient reaches:
hemodynamic instability and shock
decrease in Hb to 6g/dl or less
bleeding continues for 3 days
significant re bleeding within 1 week
what is the most appropriate management for LGIB ?
transfusion of at least 4 units of blood within 24 hours
what is the difference between guaiac positive stool
melena
and hematochezia ?
guaiac positive stool - non specific test which shows that there is blood in stool
Melena - very dark, tarry pungent stool, usually UGI
Hematochezia - spectrum: bright red blood, dark red, maroon
usually colonic orign
blood mixed with faeces is indicative of what origin?
proximal to sigmoid colon in origin
blood on the surface of the faeces is indicative of what origin ?
rectum or anal cana in origin
blood separate from the faeces is indicative of what origin ?
bleeding cancer rectum
diverticulosis
diverticulitis
Ulcerative colitis
Polyp
blood in the toilet paper is indicative of ?
minor bleeding from the anal skin
external haemorrhoids
fissure in ano
what are the differentials for bleeding per rectum with pain ?
fissure in ano
fistula in ano
carcinoma of the anal canal
ruptured perianal hematoma
ruptured anorectal abscess
endometriosis if it implants in the rectal wall
bleeding per rectum without pain
blood alone :
blood after defecation:
blood with mucus:
blood streaked on stool:
blood alone : polyp, villous adenoma, diverticular disease
blood after defecation: haemorrhoids
blood with mucus: UC, Crohn’s disease , intussusception, ischemic colon
blood streaked with stool: carcinoma of the anus
what is the most common cause of lower GI hge in adults ?
diverticular diseasee
what is the most common cause of lower GI bleeding in children ?
intussusception
( present as blood with mucus )
what is the pathogenesis of diverticulosis ?
herniation happens at the side of vasa recta ( anatomically weak position)
vessel lays over the herniation
causes bleeding
hematochezia
diverticulosis more common on the right or left side ?
left side
what is the difference between true and false diverticulosis ?
true : includes all layers of thee colon
false : missing the muscularis so very thin walled
what is angiodysplasia ?
acquired mucosal or submucosal colonic telangiectasia of degenerative origin - lacking smooth muscle
what is the fate of angiodysplasia ?
eventually form an AVM , bleeding from thee right is more common
what are haemorrhoids ?
swellings inside the canal that contain blood vessels
what are the grades to internal haemorrhoids ?
grade 1 - no prolapse, just prominent blood vessels
grade 2 - prolapse upon bearing down but spontaneous reduction
grade 3- prolapse upon bearing down but requires manual reduction
grade 4 - prolapse with the inability to manually reduced
what are the different gradings to anal fistulas ?
intersphincteric
transsphincteric
suprasphincteric
extrasphincteric
what is the most macroscopic appearance of carcinoma of the rectum ?
ulcerating
if the rectal carcinoma exists at the recto-sigmoid junction what is the macroscopic appearance of thee carcinoma ?
stenosing
what does the bleeding look like if it is associated with rectal carcinoma ?
blood streaked stool
what is the patttern of bowel habits in rectal carcinoma ?
change in bowel habits usually towards constipation
what is the presentation of recto-sigmoid junction carcinoma ?
partial obstruction as alternating constipation and diarrhea
problem with polyps ?
has malignant potential
Site of affection of Crohn’s disease ?
anywhere from mouth to anus
LGIB secondary to radiation therapy off thee rectum ?
radiation proctitis
what is a complication of meckel’s diverticulum ?
intussusception
painless bleeding
what is the rule of 2 of meckel’s diverticulum ?
happens in 2% of the population
is about 2 inches in length
is usually located within 2 feet of the ileocecal valve
present before 2 years of age
what is the most useful situation to use an NG tube in ?
patients wiith severe hematochezia and unsure if UGB oor LGIB
if an NG aspirate shows blood/coffee grounds what does this indicate ?
UGIB
what are the degrees of hypovolemic shock ?
class I - BP kwayes
class II - orthostatic hypotension
class III - reduced bp
class IV - very low, supine
what is the type of fluid used in resuscitation of hypovolemic shock ?
crystalloid fluids
when should blood transfusion be administered ?
if Hb is below 7 g/dl
1 unit of PRBC raises Hbg by 1 and HCT by 3%
what is the ratio of FFP for every unit of RBC ?
1 FFP : 4 U PRBC
what type of study has no role in lower GI bleeding ?
barium studies
when is angiography used ?
done in hemodynamically unstable patients ( requires active bleeding )
reserved for massive bleeding
what is done as screening before angiography ?
radionuclide scintigraphy
ddx of meckel’s diverticulum ?
appendicitis
large volume, painless bleeding in an adult ?
diverticulosis
small volume of bleeding, pain, diarrhea ?
colitis
