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GI II Exam 1 > Melana and Hemoxhezia > Flashcards

Melana and Hemoxhezia Flashcards

1
Q

Symptoms of UGIB and LGIB

A
  • UPPER (can present with melena, if rapid can present as hematochezia)
  • LOWER (typically present as hematochezia)
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2
Q

DDx for UGIB

A
  1. Peptic Ulcer Disease
  2. Varices (esophageal)
  3. Hemorrhagic/erosive gastritis
  4. Mallory-Weiss tear
  5. Boerhaavesyndrome
  6. Erosive esophagitis
  7. Aortoentericfistula
  8. Arteriovenous malformations/angioectasias
  9. Cancer (Esophagus, Gastric)
  10. Swallowed blood (nosebleed aka epistaxis)
  11. Anticoagulant and fibrinolytic therapy
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3
Q

DDx for UGIB

A

LOWER (typically present as hematochezia)

  1. Inflammatory Bowel Disease
  2. Ischemic colitis
  3. Diverticulosis bleed
  4. Anal fissures
  5. Hemorrhoids
  6. Polyps
  7. Cancer (Colon)
  8. Infectious colitis
  9. Arteriovenous malformations/angioectasias
  10. Varices (Colon)
  11. Radiation colitis
  12. NSAID-induced ulcers
  13. Rectal ulcer
  14. Intussusception
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4
Q

DDx for LGIB depends on the age of the patient and severity of the bleed.

DDx UNDER 50:

A
  1. Infectious colitis
  2. Anorectal disease
    1. Anal fissures, hemorrhoids
  3. IBD
  4. Meckel diverticulum
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5
Q

DDx for LGIB depends on the age of the patient and severity of the bleed.

DDx OVER 50:

A
  1. Cancer
  2. Diverticulosis
  3. Angectasias
  4. Ischemic Colitis
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6
Q

____ of hematochezia due to upper gastrointestinal source

A

10%

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7
Q

There is an increased risk of LGIB in patients taking _______________.

A

aspirin, non-aspirin antiplatelet agents, and NSAIDs.

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8
Q

2 weird things that can cause hematochezia and make doc think LGIB

A
  1. Liquid meds with red dye, as well as
  2. certain foods, such as red Kool-aid™ and beets
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9
Q

Diagnostics in ppl with LGIB

A

Evaluation with colonoscopy in stable patients

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10
Q

UGIB = melana or if rapid, hematochezia. What medications can cause this?

A

Medications with iron or bismuth

  • MVI with iron, Peptobismol
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11
Q

DIFFERENTIAL DX CONSIDERATIONS: HEMATOCHEZIA/MELENA

A

1 Diverticulosis bleed

2. IBD

3. Ischemic colitis

  1. Anorectal disease
  2. Polyps
  3. Cancer (Colon)
  4. Arteriovenous malformations/angioectasias
  5. Upper GIB
  • 1.PUD
  • 2.Varices
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12
Q

_______ is the most common cause of major lower tract bleeding, most commonly occuring in the ________.

A

Diverticulosis

Sigmoid Colon

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13
Q

Will all patients with diverticulosis be symptomatic?

A

No, 90% will have uncomplicated diverticulosis = asymptomatic

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14
Q

Diveritulosis

  • Sx
  • Diagnostics
A
  1. Acute, PAINLESS, large ovlume red poop
  2. Hemorrage, without diverticulitis, from the ascending colon.

•Evaluation with colonoscopy in stable patients, once bleeding subsides typically

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15
Q

_______ is a CD (Crohns Disaese) related gene on Chr16.

A

CARD15/NOD2

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16
Q

If patient has primary sclerosing cholangitis, think _____

A

UC

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17
Q

Appendectomy for confirmed appendicitis (before age 20) may protect against developing ____

18
Q

Crohns disease symptoms vs Chrohns

  • Type of diarrhea
  • Tx
A
  • Diarhea (w or w/o blood)
  • Pain can micmic appendicits (acute ileitis)
  • Treat
    • corticosteroids, immunomodulating agents, biologic angents, ABX

Bloody diarrhea + testmus/fecal urgency ask if stopped smokung

corticosteroids, immunomodulating agents, biologic angents, surgery = cure

19
Q

Ischemic Colitis

  • Sx
    • CC in older patients vs young patients
  • Imaging
  • Treatment
A
  • Acute vascular obstruction => sudden onset of cramping LLQ pain, desire to defecate, passage of blood or bloody diarrhea (hematochezia or BRB per rectum)
  • CC in older people = atherosclerotic disease
  • CC in younger = cocain
  • Imaging
    • Abdominal XR = thumb print
    • Sigmoidoscopy
  • Tx
    • NPO, IV, blood
    • Surgical resection
20
Q

ACUTE MESENTERIC ISCHEMIA

Sx

Imaging

Treatment

A

Periumbilical pain out of proportion to tenderness that worsens when we eat food “food fear”

  • => so they are writhing in pain, but physical exam isn’t impressive, maybe mild tenderness)don’t just think they are malingering!

Imaging

  • Abdominal XR = thumb printing = submucosal edema
  • ***** CT Angiography
  • Early celiac and mesenteric arteriography is rec

Treat

  • Laparatomy
21
Q

For EVERY anorectal disease, wht do you perform

22
Q

Hemorrhoids sx

complications

A

Bright red blood per rectum (BRBPR)-usually only drops on tissue or in toilet

Thrombosed external hemorrhoid are VERY painful

23
Q

Anal fissures

Sx

A
  • Patients complain of severe, tearing pain during defecation followed by throbbing that may lead to constipation due to fear of recurrent pain.
  • There may be mild associated hematochezia, with blood on the stool or toilet paper
24
Q

]ANORECTAL INFECTIONS cause ________,, which are mostly transmitted __________.

It is important to dinshuish these from ________/

A

Proctitisis characterized by:

  • anorectal discomfort, tenesmus, constipation, and mucus or bloody discharge

sexually transmitted, especially by anal sex

must be distinguished from noninfectious causes

25
Q
  • How do you test for N. Gonnarhea
  • Trepemona Pallidium?
  • chlamydia
A
  1. Rectal swab for during anoscopy for culture + pharynx + urethra/cervix
  2. Scrape chancer/condylomas and use dark-field microscopy or flurorecent Ab testing => requires proper eqiupment and trained ppl
  3. Serology, culure or PCR testing of rectal discharge or rectal biopsy
26
Q

MCC of Anorectal infection is _______, how do we diagnose?

A

HSV2

  • Get vesicle fluid and do [viral culture, PCR or antigen detection assays]
27
Q

In Condylomata acuminate-anal conylomas (genital warts), what is the most important?

A
  • Warts must be distinguihsed from conyloma lata (secondary syphillus) or anal cancer; thus, bipsy large or suspiosus lesions!
  • HPV vaccines, especially for MSM
28
Q

________ is a common etiology for anal cancer

29
Q

PERIANAL PRURITUS (PRURITUS ANI) does not necesarrily present as hemotachezia , but it is ____

A

perianal itching and discomfort

30
Q

What types of polyps have the most signifiant implication

A

Adenomatous polyps and serrated polyps

31
Q

It is important to consider HEREDITARY COLORECTAL CANCER & POLYPOSIS SYNDROMES in whom

A
    1. FHx of colorectal cancer that has affected >1 family member
    1. Personal or fmaily Hx of colorectal cancer deveoping early (before 50)
    1. FHx or multuple polpys (>20)
    1. FHx of multiple extracolonic cancers
32
Q

FAP (Review deck on H&P, how to treat)

Lynch Sndruome

Nonfamilial adenenmouts and serated (review card)

Harmatomatous polpyposos sundrome (Review card)

33
Q

Colorectal cancer screen should be down when?

A
  • Start regular screening from 45- 75.
    • From 76-85; only do it based on persons prefercence, life expentancy, overal health and prior screen
    • Over 85= do not screen
      *
34
Q

Above average risks for Colorectal cancer include:

A
    1. 1st degree relative with cancer before 60 or 2 first degree relatives at any age: screen starting at 40 for ever 5 years or 10 years ebfore youngest age was affected.
  • 2. Inherited FAP: genetic testing/anual screening by sigmoidoscopy starting at 10-12
  • 3. Inhereited HNPCC: genetic testing or colonoscopy every 1-2 yrats begning at ages 20-25 or 10 years younger than younger age of person w colorectal cancer.
35
Q

How do wetest and screen for colorectal cancer?

A
    1. Fecal occult blood test
  • 2. FIT (Fecal immunochemical test) => MORE sensitive
36
Q

review AVM

UGI Bleeds: PUD

37
Q

_______ is commonly due to portal HTN and found in 50% of patients with _____, causing UGI bleeds.

A
  • Espohageal varices
  • Cirrhosis
38
Q

Symptoms of esophageal varices

Treat?

A
  • Asx, but can cause acute GI hemorrhage => melena, hematoxhezia, and hematemisis.
  • Treat
    • Acute resucuitaiton
        1. (rapidly access and resuccistate with IV fluids and blood)
        1. Fresh frozen plasma and platemants and IV Vit K because most have coagulopathy due to underlying conitions
    • EMERGENT EGD + variceal banding
39
Q

Other tx of esophageal varices

A
  1. ABX propgylaxis
  2. Somatostatin and octreotide
  3. Lactulose
  4. Baloon tampomade
  5. Travenous intrahepatic portosystemic shint (TIPS)
  6. Liver transplant
40
Q
  • Diagnose Meckles Diverticulim, which can cause rectal bleeding
  • Treatment
A

1. Technetium 99-scan

Treat with surgical resection

GI II Exam 1 (19 decks)

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