Melena and Hematochezia DSA Flashcards
How does an UGIB typically present? LGIB?
a. melena (if rapid, can be hematochezia)
b. hematochezia
When is a bleed defined as LGIB?
when it is distal to the ligament of Treitz
*LGIBs are less likely than UGIB to present with shock, orthostasis, or to require transfusions
Alcohol use can cause what type of varices?
esophageal (UGIB)
colonic (LGIB)
What medications can cause a GIB?
- NSAIDs
- Anticoagulants
- Medications with iron or bismuth
- MVI with iron, Peptobismol
*Liquid medications with red dye, as well as certain foods, such as red Kool-aidTM and beets, can simulate hematochezia
What treatment is done for both upper and lower GIBs? Specifically for UGIB?
- Stabalize, two large bore IVs, fluid bolus (if in shock), blood tranfusion (if needed), labs (cbc, chem profile…)
- PPI, Ocretoide (varices - inhibits gastric acid secretion, dec BF to gastroduodenal mucosa, splanchnic vasoconstriction), ABs (if variceal bleed)
What is the etiology of diverticulosis?
unknown - possibly low fiber diet or increaed intraluminal P
What is diverticulosis?
outpouching of the colon mucosa (most commonly sigmoid) through the muscularis at point of nutrient a. entry
most common cause of major LGIB
hemorrhages tend to be self limited and painles
What disease is associated with lead pipe colon? cobblestoning? fat wrapping?
lead pip - UC
fat wrapping, cobblestoning - CD
How do UC pts present? CD?
a. rectal bleeding, bloody diarrhea, left sided abd pain, tenesmus, wt loss
b. N/V, diarrhea, RLQ abd pain, wt loss, acute ileitis
What is a shared and feared complication of UC and CD?
colon CA
increased risk with long duration of disease, FH, extensive disease, PSC, strictures, post inflamm pseudopolyps
What is seen in 70% of pts with UC? 60-70% of pts with CD?
a. UC - serum ANCA
b. CD - antibodies to Saccharomyces cerevisiae (ASCA)
What is a lead pipe sign? string sign?
a. loss of haustra in UC
b. narrowing from inflammation or stricture in CD
What imaging is better for CD pt pelvic lesion concerns?
MR > CT
How do you treat CD?
antibiotics
corticosteroids, immunomodulating agents, biologic agents
colon cancer surveillance
obstruction –> IVG with NG suction
percutaneous drainage of abscesses
surgery (only if necessary - can lead to worsening disease or malabsorption)
List the types of CD fistulas
Which IBD has a better outcome with surgery?
UC - can be curative
27 y/o presents to ED via ambulance. She had been on mile 25 of her marathon, when she experienced sudden cramping in her abdomen. She ran to the restroom, and passed blood diarrhea at which point she called over a medic. You first order an xray (see below). What is the dx?
ischemic colitis
What might acute mesenteric ischemia be confused with and why?
malingering - their pain is out of proportion to tenderness
other signs: food fear, thumb printing
CT angiography is diagnostic study of choice
tx: restore blood flow or cut out necrotic tissue
What is the cause of anal fissures?
trauma during defecation
leads to linear or “rocket shaped” ulcers usually less than 5mm
What organisms can cause anorectal infections?
Neisseria gonorrhorea
Treponema Pallidum
Chlamydia Trachomatis
Herpes Simplex Type 2
Condylomata Acuminata - Anal Conylomas (HPV)
Who is a risk for anal cancer?
F > M
homosexual men are at increased risk
What are the four groups of polyps?
What can be present at birth to indicate FAP?
congenital hypertrophy of the retinal pigment epithelium
What mutations are seen in FAP?
90% - APC - AD
8% - MUTYH - AR
15% - sporadic
What are the guidelines for colorectal cancer screening (average risk)?
What is the most useful method of diagnosis of Meckel’s?
technetium - 99m scan
