Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Gastrointestinal II Exam #1 > Melena and Hematochezia DSA > Flashcards

Melena and Hematochezia DSA Flashcards

1
Q

What structure designates a LGIB vs. UGIB?

Which are more worrisome?

A

Ligament of Treitz

Generally UGIB are more worrisome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

DDx of LGIB in a patient >50 y/o

DDx of LGIB in a patient <50 y/o

A

> 50 y/o: malignancy, diverticulosis, angiectasia, ischemic colitis

<50 y/o: infectious colitis, anorectal fissures, IBD, Meckel’s diverticulum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Dx of LGIB usually requires…

A

Colonoscopy, only in stable patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What meds can cause a GI bleed?

A

NSAIDs
Aspirin
Glucocorticoids
Anti-coagulants

**Meds with iron or bismuth (pepto bismol)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Most common cause of major LGIB is:

Where does it occur most commonly?

90% of patients are…

A

Diverticulosis

Sigmoid colon

Asx - detected on barium enema or colonoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Sx of bleed with diverticulosis

A

Acute, painless, large-vol maroon or bright red stool

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Tx of divericulosis

A

Diet change - increase fiber, etc.
Hemodynamic support if hemorrhage
2 large bore IVs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Crohn disease is associated with which finding on XR?

UC?

A

String sign (strictures)

Lead pipe sign (loss of haustra)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which IBD: CD or UC?

Usually bloody diarrhea

A

UC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which IBD: CD or UC?

Toxic megacolon

A

UC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which IBD: CD or UC?

CARD15/NOD2

A

CD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Which IBD: CD or UC?

Ulcerated pseudopolyps

A

UC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is seen on histology/colonoscopy of CD?

A

Aphthous ulcers intervening with normal mucosa
“Cobble-stoning”
Thickened bowel wall
“Creeping fat”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Which IBD: CD or UC?

Rectal involvement (almost always)

A

UC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which IBD: CD or UC?

Most common site of involvement is terminal ileum

A

CD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What antibodies are tested in IBD?

Which diseases are they more specific for?

A

ANCA - UC

ASCA - CD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

+ stool fecal lactoferrin indicates..

A

Intestinal inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

+ stool fecal calprotectin

A

Predicts relpases and detectes pouchitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Sx of CD

A 
RLQ pain
Diarrhea (w/o blood)
Acute ileus (mimics appendicitis)
Abscesses
Strictures
Fistulas
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Fist-line of treatment for IBD

A

Corticosteroids, then immunomodulating/biologics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Complications of Crohn disease include…

A

Gallstones
Kidney stone
Colon CA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Which IBD: CD or UC?

Fistulas are common

A

Fistulas are common in CD!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Sx of UC

A 
Bloody diarrhea
Tenesmus/fecal urgency
Recently stopped smoking? (smoking tends to be protective)
Wt loss
Eryhthema nodosum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Complications of UC

A

Hemorrhage
Colon CA
Toxic megacolon
Colon perforation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Extra-intestinal complications of IBD at the following locations:

Eyes
Kidneys
Skin
Mouth
Liver
Biliary tract
Joints
Circulation
A

Eyes: uveitis, episcleritis
Kidneys: stones, fistula, UTI
Skin: erythema nodosum, pyoderms gangrenosum
Mouth: aphthous ulcers, stomatitis
Liver: steatosis
Biliary tract: gallstones, sclerosing cholangitis
Joints: spondylitis, sacrolitis, arthritis
Circulation: phlebitis

26
Q

Onset of ischemic colitis

What is the major risk factor?

What ages?

A

Sudden onset of cramping in LLQ
Desire to defecate
Passage of blood/bloody stool

Atherosclerosis is major risk factor

Older patients

27
Q

Thumb-printing on XR is seen in what disease?

A

Ischemic colitis

28
Q

Imaging used for iscemic colitis (2)

A

Abdominal XR - thumb-printing

Sigmoidoscopy

29
Q

Acute mesenteric ischemia presentation:

What is a unique symptom?

What is the study of choice?

What is the treatment?

A

Perimubilical pain out of proportion of tenderness (lots of pain, but PE is unremarkable)

“Food fear” - pain is worse after eating

CT angiography

Laparotomy to restore blood flow

30
Q

Hemorrhoids major presenting sign:

How do they occur?

What is the major complication?

A

BRBPR - in drops or on toilet paper

Increased hydrostatic pressure in hemorrhoidal venous plexus
-straingin at stool (associated w/ pregnancy)

Thrombosed external hemorrhoid: onset by heavy cough, lifting, straining

31
Q

Anal fissures definition:

What is the presentation?

A

Linear/rocket-shaped ulcers usually 5 mm in length

Severe, tearing pain during defecation followed by throbbing discomfort, which may lead to constipation
Possible hematochezia

32
Q

What is the major cause of proctitis?

What symptoms characterize it?

A

Sexually transmitted, usually by anal intercourse

Anorectal discomfort, tenesmus, constipation and mucous/bloody discharge

33
Q

What 5 bugs can cause anorectal infections? Where should cultures come from?

A 
N. gonorrheae
Treponema pallidum
Chlamydia trachomatis
HSV-2
Condylomata acuminata (HPV - genital warts)
34
Q

How is N. gonorrheae cultured?

A

Anal culture, as well as pharynx and urethra in men, and pharynx and cervix in women

35
Q

Treponema pallidum is diagnosed with…

A

Dark-field microscopy or fluorescent Ab testing

36
Q

Chalmydia trachomatis may cause…

There have been increasing cases in which patients?

What establishes a Dx?

A

Lymphogranuloma venereum - proctocolitis with fever and bloody diarrhea, perianal ulcers, strictures and fistulas, and inguinal adenopathy.

Gay men

Serology, culture or PCR testing of rectal discharge

37
Q

HSV-2 symptoms onset how long after exposure?

How it is diagnosed?

When does it resolve?

A

4-21 days

Viral culture, PCR or Ag detection

Within 2 wks, but viral chedding may continue for a few wks.

38
Q

Anal warts (HPV) should be distinguished from which pathogies?

Where should Bx come from?

Who should get vaccinated for it?

A

Conyloma lata (secondary syphilis) or anal cancer

Large or suspicious lesions

All people from ages 9-26 (especially women and gay men)

39
Q

Anal cancer is predominantly caused by:

Which patients are at a greater risk?

What is it associated with?

What is the presentation?

A

HPV is etiologic

Women and gay men

Chronic irritation (infection, anal sex, hemorrhoids, leukoplakia, etc.)

Bleeding, pain and perianal mass

40
Q

What are some treatments for anal cancer?

A

Radiation and chemo

Abdominoperineal resection with permanent colostomy is reserved for patients with large lesions or reoccurence post-chemo

41
Q

What is the most common organ that anal cancer metastasizes to? Why?

A

Lungs, due to the paravertebral venous drainage

42
Q

Perianal pruritis etiologies:

Treated by…

A

Poor hygiene
Contact dermatitis, atopic dermatitis, bacterial infections, STD, skin conditions, etc. can cause pruritis and should be excluded.

Education is important, but otherwise, topical glucocorticoids and anti-fungals if indicated.

43
Q

What are the 4 major pathologic polyps?

Which one is most common?
Which have significant clinical implications?

A

Mucosal adenomatous polyps - tubular, tubulovillous, villous - 70% (most common) and clinically important

Mucosal serrated polyps - clinically important

Mucosal non-neoplastic polyps - juvenile, hamartomatous, inflammatory polyps

Submucosal lesions - lipomas, lymphoid aggregates, etc.

44
Q

What 4 things might suggest that a patient has an increased risk of having a familial colon cancer?

A

Family Hx of colorectal cancer in more than 1 person

Personal or family hx of colorectal cancer <50 y/o

Personal or family hx of multiple polyps (>20)

Personal or family hx of multiple extra-colonic malignancies

45
Q

Familial adenomatous polyposis (FAP) is indicated by the presence of…

What is the major extra-intestinal manifestation?

90% have a mutation in which gene in what kind of inheritance?
8% have a mutation in what other gene in what kind of inheritance?

A

Hundreds to thousands of colonic adenomatous polyps

Congenital hyperplasia of the RPE (detected at birth)

90% - APC gene in AD fashion
8% - MUTYH gene in AR fashion

46
Q

What are the 2 manners of treatment for FAP?

A

Complete proctocolectomy w/ ileoanal anastomosis before age 20

Prophylactic colectomy to prevent inevitable colon cancer

47
Q

Lynch syndrome (HNPCC) is associated with which 2 major malignancies?

How fast do polyps become malignant?

What genes are implicated and what is their function? Inheritance?

A

Colorectal cancer (22-75%) and endometrial cancer (30-60%) - other cancers can develop at a young age

Rapid transformation from normal tissue to adenomas - cancer in 1-2 years

MLH1 and MSH2 - DNA mismatch repair genes - AD

48
Q

Multisociety guidelines recommend that all colon cancers should undergo…

A

Testing for Lynch syndrome, with either immunohistochemistry or microsatellite instability

49
Q

What is the treatment for Lynch syndrome?

What should women have done?

When should screening be done for gastric cancer and how frequently should it be done?

A

Subtotal colectomy w/ ileorectal anastomosis (w/ annual surveillance)

Women should have a prophylactic hysterectomy and oopherectomy at 40 y/o or after they are done having kids

Upper endoscopy for gastric cancer every 2-3 yrs beginning at 30 y/o

50
Q

Clinical findings in non-familial adenomatous and serrated polyps include:

What is the main way they are treated and monitored?

A

They are completely asymptomatic, but may show some blood loss and lead to iron deficiency anemia

Colonoscopic polypectomy if needed, but there is risk for bleeding and perforation
Postpolypectomy surveillance - periodic colonoscopies post removal of polyps

51
Q

What endoscopic test is most useful in diagnosing non-familial adenomatous and serrated polyps?

A

Colonoscopy - best test to detect and treat colorectal polyps

52
Q

Hamatomatous polyps include which 3 disease?

What are some characteristics of each?

A

Peutz-Jeghers

  • hamartomatous polyps throughout GI, mostly in SI
  • mucocutaneous pigmented macules in lips, buccal mucosa and skin*

Familial juvenile polyps

  • > 10 polyps in colon
  • 50% increased risk for colon cancer, but to synchronous adenomatous polyps or mixed hamartomatous-adenomatous polyps

PTEN hamartoma syndrome (Cowden disease)

  • hamartomas and lipomas throughout GI tract, and trichilemmomas (benign skin neoplasm on neck and head) and cerebellar lesions
  • increased rate of malignancies in thyroid, breast and GU tract
53
Q

What is the inheritance and genes associated with Peutz-Jeghers syndrome and Familial juvenile polyposis?

A

J-P syndrome: AD - STK11 gene

FJP - AD - MADH4 and BMPR1A genes

54
Q

Gardner’s syndrome is associated with which polyps?

What are extra-intestinal manifestations?

Inheritance?

A

Adenomatous colon polyps

Osteomas of mandible, skull and long bones
Supernumerary teeth
Thyroid and adrenal tumors

AD

55
Q

Turcot’s syndrome is associated with which polyps?

What is the major extra-inestinal manifestation?
What is another major association?

Inheritance?

A

Adenomatous colon polyps

Brain tumors
Colorectal cancer in 100% of pts. over 40 y/o

AD

56
Q

ACS guidelines for colorectal screening for patients at average risk

A

Begin regular screening at 45 y/o, and continue until 75 y/o

For pts. > 75 y/o, screening is done based on pt. preference

Pts. > 85 should not be screened, unless they have:

  • hx of cancer/multiple polyps
  • hx of IBD
  • confirmed Lynch syndrome, FAP, etc.
  • hx of radiation to belly
57
Q

ACS guidelines for colorectal screening for patients at above-average risk

For FAP?

For Lynch syndrome?

A

First-degree relatives with colorectal cancer or adenomas <60 y/o
-colonoscopy every 5 yrs, beginning at 40 y/o or 10 yrs prior to the age tha the youngest family member was diagnosed

FAP: genetic testing or annual sigmoidoscopy beginning at 10-12 y/o

Lynch syndrome: genetic testing or colonoscopy every 1-2 yrs beginning at 20-25 y/o, or 10 yrs younger than the age the youngest family member was diagnosed

58
Q

Colon adenocarcinoma is most common at what age?

Pts. with a strong family history of malignancy generally have tumors where? What infection has a high prevalence?

What is the major site of metastasis?

A

> 45 y/o

Right colon, Strep. bovis bacteremia

Liver

59
Q

What are symptoms more common to right sided and left sided colon cancers?

A

Right: anemia, occult blood in stool, weight loss, perforation, fistulas

Left: rectal bleeding, abn. bowel habits (GI complaints), abdominal/back pain

60
Q

What helps with early Dx of colon adenocarcinoma?

A

Screening Asx patients with fecal occult blood testing

61
Q

Arteriovenous malformations (AVM - Angioectasias)

Symptoms?

Pts. with what other 2 diseases are commonly implicated? What age?

Diagnostics include (2)

A

Painless bleeding, ranging from melena to hematochezia (if proximal to ligament of Trietz it will be melena, etc.)

> 70 y/o with aortic stenosis or chronic renal failure

CBC with iron studies
Endoscopic evaluation

Gastrointestinal II Exam #1 (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions