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year 5 - GIT surgery > lower GIT hge > Flashcards

lower GIT hge Flashcards

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1
Q

what is considered upper GI bleeding ?

A

intraluminal blood loss from a source distal to the treitz ligament

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2
Q

where is the treitz ligament ?

A

at the duodenojejunal flexure
3rd part of the duodenum

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3
Q

what do we consider as massive LGIB ?

A

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

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4
Q

what is the most appropriate management for LGIB ?

A

transfusion of at least 4 units of blood within 24 hours

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5
Q

what is the difference between guaiac positive stool
melena
and hematochezia ?

A

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

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6
Q

blood mixed with faeces is indicative of what origin?

A

proximal to sigmoid colon in origin

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7
Q

blood on the surface of the faeces is indicative of what origin ?

A

rectum or anal cana in origin

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8
Q

blood separate from the faeces is indicative of what origin ?

A

bleeding cancer rectum
diverticulosis
diverticulitis
Ulcerative colitis
Polyp

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9
Q

blood in the toilet paper is indicative of ?

A

minor bleeding from the anal skin
external haemorrhoids
fissure in ano

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10
Q

what are the differentials for bleeding per rectum with pain ?

A

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

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11
Q

bleeding per rectum without pain

blood alone :
blood after defecation:
blood with mucus:
blood streaked on stool:

A

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

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12
Q

what is the most common cause of lower GI hge in adults ?

A

diverticular diseasee

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13
Q

what is the most common cause of lower GI bleeding in children ?

A

intussusception

( present as blood with mucus )

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14
Q

what is the pathogenesis of diverticulosis ?

A

herniation happens at the side of vasa recta ( anatomically weak position)
vessel lays over the herniation
causes bleeding
hematochezia

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15
Q

diverticulosis more common on the right or left side ?

A

left side

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16
Q

what is the difference between true and false diverticulosis ?

A

true : includes all layers of thee colon
false : missing the muscularis so very thin walled

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17
Q

what is angiodysplasia ?

A

acquired mucosal or submucosal colonic telangiectasia of degenerative origin - lacking smooth muscle

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18
Q

what is the fate of angiodysplasia ?

A

eventually form an AVM , bleeding from thee right is more common

19
Q

what are haemorrhoids ?

A

swellings inside the canal that contain blood vessels

20
Q

what are the grades to internal haemorrhoids ?

A

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

21
Q

what are the different gradings to anal fistulas ?

A

intersphincteric
transsphincteric
suprasphincteric
extrasphincteric

22
Q

what is the most macroscopic appearance of carcinoma of the rectum ?

A

ulcerating

23
Q

if the rectal carcinoma exists at the recto-sigmoid junction what is the macroscopic appearance of thee carcinoma ?

A

stenosing

24
Q

what does the bleeding look like if it is associated with rectal carcinoma ?

A

blood streaked stool

25
Q

what is the patttern of bowel habits in rectal carcinoma ?

A

change in bowel habits usually towards constipation

26
Q

what is the presentation of recto-sigmoid junction carcinoma ?

A

partial obstruction as alternating constipation and diarrhea

27
Q

problem with polyps ?

A

has malignant potential

28
Q

Site of affection of Crohn’s disease ?

A

anywhere from mouth to anus

29
Q

LGIB secondary to radiation therapy off thee rectum ?

A

radiation proctitis

30
Q

what is a complication of meckel’s diverticulum ?

A

intussusception
painless bleeding

31
Q

what is the rule of 2 of meckel’s diverticulum ?

A

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

32
Q

what is the most useful situation to use an NG tube in ?

A

patients wiith severe hematochezia and unsure if UGB oor LGIB

33
Q

if an NG aspirate shows blood/coffee grounds what does this indicate ?

A

UGIB

34
Q

what are the degrees of hypovolemic shock ?

A

class I - BP kwayes
class II - orthostatic hypotension
class III - reduced bp
class IV - very low, supine

35
Q

what is the type of fluid used in resuscitation of hypovolemic shock ?

A

crystalloid fluids

36
Q

when should blood transfusion be administered ?

A

if Hb is below 7 g/dl

1 unit of PRBC raises Hbg by 1 and HCT by 3%

37
Q

what is the ratio of FFP for every unit of RBC ?

A

1 FFP : 4 U PRBC

38
Q

what type of study has no role in lower GI bleeding ?

A

barium studies

39
Q

when is angiography used ?

A

done in hemodynamically unstable patients ( requires active bleeding )
reserved for massive bleeding

40
Q

what is done as screening before angiography ?

A

radionuclide scintigraphy

41
Q

ddx of meckel’s diverticulum ?

A

appendicitis

42
Q

large volume, painless bleeding in an adult ?

A

diverticulosis

43
Q

small volume of bleeding, pain, diarrhea ?

A

colitis

year 5 - GIT surgery (8 decks)

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