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GI2 E1 > melena and hematochezia > Flashcards

melena and hematochezia Flashcards

clinical

1
Q

differentiate between the sx of upper and lower GI

A

upper= melena, can present to hematochezia

lower= hematochezia

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2
Q

ddx for pts under 50 yo w lower gi bleed

A

infectious colitis
anal fissures, hemorrhoids
IBD
meckels

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3
Q

ddx for patients over 50 with lower gi bleed

A

malignancy
diverticulitis
angiectasias
ischemic colitis

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4
Q

define the location of a LGIB

A

below the Lig of Treitz (past duodenum part 3)

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5
Q

prognosis of UGIB vs LGIB

A

LGBI is more likely to be benign, less likely to present w shock, 75% spontaneously stop bleeding

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6
Q

serious LGIB is more common in who

A

older men

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7
Q

increased risk of LGIB in patients taking

A

aspirin, other antiplatelets, NSAIDs

multivitamin w iron, peptobismol

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8
Q

LGIB with hx of EtOH abuse

A

colonic varices

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9
Q

increased risk of UGIB in patients taking

A 
aspirin
glucocorticoids
NSAIDs
anticoag
MVI w iron, peptobismol
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10
Q

octreotide consumption can inhibit secretion of ___, reduce ____ to the gastroduodenal mucosa, and cause ____ vasoconstriction in patient with varices

A

gastric acid
blood flow
splanchnic

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11
Q

etiology of diverticulosis, most common location

A

herniations or sac like protrusions of the mucosa at the points of nutrient A penetration

sigmoid colon

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12
Q

most common cause of major LGIB

A

diverticulosis

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13
Q

sx, dx, trx of diverticulosis

A

sx= acute, painless, large volume maroon or red blodd in pts over 50, hemorrhage, but 90% are asx

dx= colonoscopy in stable pts, INR/pt/Ptt, CBC

trx=if uncomplicated, high fiber intake and antichol, hemorrhage, also fluid bolus or blood transfusion as needed

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14
Q

patients with IBD have been shown to have ___ intestinal permeability, and ____ impairment of structure and function

A

increased, irreversible

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15
Q

T cell types and interleukins in crohn vs UC

A

Crohn= Th1 + Th17, TNF/IFN-g, IL17

UC= Th2 type, IL-5, IL-13

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16
Q

UC= L_Q pain and Crohn= L_Q pain

A 
UC= LLQ
Crohn= CRQ
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17
Q

crohn

pattern of lesions
locations of lesions
complications
histo

A

skip lesions, transmural

anywhere in GI trat, discontinuous, mostly in terminal ileus and colon, perianal ds is common

fistulas, strictures, “string sign” on US, bile salt malabsorption, gallstones,

coble-stoning on scope, thickened wall, fat wrapping of colon

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18
Q

ulcerative colitis

pattern of lesions
locations of lesions
complications
histo

A

continuous, superficial

from rectum proximal, not the entire colon

lead pipe sign on xray

loss of haustra, crypt distortion, ulceration, severe hemorrhage, pseudopolyps, toxic megacolon

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19
Q

while smoking is ___ in ulcerative colitis, it ____ crohn’s

A

protective

worsens

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20
Q

gene mutation related to crohn

A

CARD15/NOD2

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21
Q

populations in which IBD is present

A

bimodal age= 20s-40s and then 70s-90s
jewish + whites
high SES, hx of abx use in the first year of life

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22
Q

increase risk of what infectious agents with IBD

A

salmonella
shigella
campylobacter
C Dif

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23
Q

serum Ag levels of ___ are seen with ulcerative colitis, and of ___ in crohn

A

ANCA

ASCA

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24
Q

what does fecal lactoferrin indicate

A

intestinal inflammation (think IBD)

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25
Q

what does fecal calprotectin indicate

A

predict relapses and detect pouchitis

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26
Q

diagnostic imaging for IBD

A

single contrast barium enema
CT w contrast, CT/MR Enterography
sigmoidoscopy, colonoscopy
EGD

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27
Q

sx of crohn

A 
RLQ pain
fever
diarrhea no blood
growth retardation
acute ileitis looks like appendicitis
anorectal rissure
28
Q

trx for crohn and ulcerative colitis

A

5-aminosalicylic acid derivatives corticosteroids, immunomodulating agents, biologic agents

(for Crohn also add abx, IVF w NGT suction)

29
Q

sx of ulcerative colitis

A

6+ bloody BMs/day, tenesmus/fecal urgency, systemic vasculitis,

30
Q

sx and dx of toxic megacolon

A

super sick
shock, sicker than they have ever been

dont want to increase the P or will perforate, so get a plain Xray and call surgery

31
Q

extra-intestinal manifestations of IBD (7)

A 
pyoderma gangrenosum (UC)
oral aphthous ulcer (early sx in crohn)
iritis
anterior uveitis
toxic megacolon (UC)
erythema nodusum
ankylosing spondylitis
32
Q

hx of ischemic colitis

A

sudden onset of cramping LLQ pain, desire to defecate, passage of bloody diarrhea

in older patients with atherosclerotic ds
in younger patients with cocaine use

33
Q

dx and trx of ischemic colitis

A

thumb printing on abd xray,
sigmoidoscopy w submucosal hemorrhage, friability, and ulceration

trx= NPO, IV fluids, surgical resection

34
Q

hx of acute mesenteric ischemia

A

periumbilical pain out of proportion to tenderness

writhing in pain but physican exam isn’y impressive

“food fear”, abd pain worsens after eating

35
Q

dx and trx of ischemic colitis

A

dx= thumb printing on xray, submucosal edema
CR angiography

trx= restore intestinal blood flow past an obstruction via laparotomy, post op anticoag in mesenteric venous thrombosis

36
Q

hx, dx, trx of hemorrhoids

A

hx= increased P in venous plexus with straining to poop or pregnancy, bright red blood drops on tissue,

dx on anal inspection or anoscopy

trx= bulk laxative and stool softeners, analgesics, rubber band ligation or injection sclerotherapy

37
Q

complications of hemorrhoids

A

thrombosed external hemorrhoid

acute, exquisite pain, tense, bluish perianal nodule

38
Q

etiology of an anal fissure

A

linear or rocket shaped ulcers due to trauma to the anal canal during defecation

39
Q

hx, dx, trx of anal fissure

A

hx= severe, tearing pain during defecation followed by throbbing discomfort
maybe a little bit of blood

dx= external anal inspection or anoscopy

trx=fiber supplements, sitz baths, topical anesthetics, relaxation of anal canal w nitroglycerin ointment,
internal anal sphincterotomy in refractory cases

40
Q

anaorectal infections can lead to __, characterized by anorectal discomfort, tenesmus, constipation, and discharge

A

proctitis

41
Q

most cases of proctitis are transmitted ___, especially ___

A

sexually

anal receptive

42
Q

dx of N. gonorrhea anorectal infection

A

cultures from pharynx urethra (M) / cervix (F)

43
Q

dx of treponema pallidum anorectal infection

A

dark field microscopy or flourescent Ab, VDRL or RPR test

44
Q

dx of chlamydia trachomatis

A

serology, culture, PCR

45
Q

hx with chlamydia anorectal infection

A

proctocolitis w fever, bloody diarrhea, perianal ulcerations, anorectal strictures, fistulas, inguinal adenopathy, MSM

46
Q

dx of herpes simplex type 2 anorectal infection

A

viral culture, PCR, or Ag detection

viral shedding for several weeks after resolution

47
Q

anal CA can be associated with chronic irritation from

A 
condyloma acuminata
perianal fissures/fistulas
chronic hemorrhoids
leukoplakia
trauma from anal intercourse
48
Q

etiology of anal ca

A

HPV virus

49
Q

populations and hx associated with anal CA

A

women and MSM

bleeding, pain, perianal mass

50
Q

trx and complications of anal CA

A

trx= radiation therapy plus chemo

complications= tumors may spread to the lung early on

51
Q

etiology of pruritis ani

A

poor anal hygeine, or overzealous cleansing with soaps

52
Q

hx, dx, trx of pruritis ani

A

hx= perianal itching and discomfort

dx= external anal inspection or anoscopy

trx=education, premoistened wipes, topical glucocorticoid, and anti-fungal agent if indicated

53
Q

most polyps are what kind

A

mucosal adenomatous polyps

54
Q

FAP sx and dx and trx

A

early development of 100s-1000s of polyps

detect w gene detection of APC and/or MUTYH gene

trx= complete proctocolectomy with ileoanal anastomosis
prophylactic colectomy

55
Q

etiology of lynch syndrome

A

lifetime risk of colorectal cA, endometrial CA, and other CAs developing at a young age

polyps undergo rapid transformation over 1-2 years from normal tissure –> adenoma –> CA

56
Q

dx, trx of lynch syndrome

A

dx= genetic counseling to look for x mismatch repair mechanism, immunohistochemical staining

trx= subtotal colectomy w ileorectal anastomosis with annual surveillance of the rectal stump

women undergo screening for endometrial/ovarian CA at 30
prophylactic hysterectomy

57
Q

hx, dx, trx w nonfamilial adenomatous & serrated polyps

A

hx= mostly asx but all the bleeding can cause anemia

dx= barium enema, CT colongraphy, COLONOSCOPY IS THE BEST = most sensitive

trx= postpolypectomy surveillance

58
Q

three syndromic presentations in which you will see hamartomous polyps

A

peutz-jeghers syndrome= HP throughout GI tract, may lead to gelatinous stools (s/p intussusception), mucocutaneous pigmented macules on the lips, buccal mucosa, and skin

familial juvenile polyposis= more than juvenile HPs most commonly in colon, increase risk of adenocarcinoma

PTEN multiple hamartoma syndrome (Cowden)

  • HPs and lipomas throughout the GI tract, and cerebellar lesions
  • increased rate of malignancy in thyroid, breast, and urogenital tract
59
Q

what makes someone have an above avg risk for colorectal CA

A
  • get a colonoscopy every 5 years starting at 40 or 10 yrs before the staring age of youngest relative w it if have
    • first degree relative, dx at<60 or two first degree relatives at any age
  • get colonoscopy every 5 years starting at 40 if
    • first degree relative w colorectal CA or adenoma dx at >60, or teo second degree relatives with colorectal CA
60
Q

screening and tests for colorectal CA

A

FOBT, FIT, and fecal DNA tests

61
Q

strep bovi bacteremia in ppl >45 is associated with

A

adenocarcinoma of the colon

62
Q

left sided colon CA presents with

vs right sided colon CA presenting with

A

left= rectal bleeding, altered bowel habits, abd/back pain

right= anemia, occult blood, weight loss, other

63
Q

hx and dx of AVM

A

= angiodysplasia
-painless bleeding/occult blood loss,
-common hx of chronic renal failure or aortic stenosis
if proximal to Lig or Treitz, can present with melena

dx=
CBC, iron studies, endoscopic workup

64
Q

TIPS procedure is for

A

long term decreased portal HTN

65
Q

trx for stomach ulcer

A

IV pantoprazole (PPI)

66
Q

normally, start transfusion therapy if Hgb is less than

in CAD, start transfusion therapy if Hgb is less than

A

7

10

67
Q

giving someone iron can cause what s.e.

A

constipation

darker colored urine

GI2 E1 (19 decks)

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