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
List the types of CD fistulas
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 are the four groups of polyps?
What are the guidelines for colorectal cancer screening (average risk)?
