Melena, Hematochezia, Occult GIB Flashcards
Name Ddx’s for an UGIB
PUD Esophageal Varices Mallory-Weiss Syndrome Boerhaave Syndrome Arteriovenous Malformations/Angioectasias
Name Ddx’s for a LGIB
IBD Ischemic Colitis Diverticulosis Anal Fissures Hemorrhoids Cancer Infectious Colitis
What is Occult GI bleeding, and what is the most common cause?
Bleeding that is not apparent. Most common cause include: 1) Neoplasm 2) Angioectasias 3) Crohn's
Who is iron deficiency anemia a normal finding?
Premenopausal, menstrating women.
Pregnant woman
What is an automatic differential if a person has occult bleeding as over the age of 45?
Colon Cancer
Ddx list for patients under 50
- Infectious Colitis
- Anorectal problem (fissure, hemorrhoid)
- IBD
- Meckel’s Diverticulum
Ddx list for patients over 50
- Malignancy
- Diverticulosis
- Angiectasias
- Ischemic Colitis
A 30 year old male presents panicking because his stool is bright red. He has no family history of cancer, eats a fibrous diet, and exercises regularly. After interviewing him, you smile and tell him this is not an emergency. What is the most likely cause of his red stool?
The beet smoothie he colored red and mixed with koolaid… OH YEAAAH
Describe a Diverticulosis
Herniation of the mucosa through the muscularis, creating a pouch that could become impacted/perforate. Most common in Sigmoid Colon
Can have bright red stool, often asymptomatic
Evaluate with Colonoscopy
Dr. Shnyra bursts through the door during your exam waiving an AK-47 and asks you point blank “what immune cell is implicated in the development of IBD?” Answer wrong and you die.
T-regulatory Cells
You got Shnyra’s question right, but now Mcgowen walks in and asks you how to differentiate UC from CD using serum testing. What is your answer?
UC: +ANCA, -ASCA
CD: +ASCA, -ANCA (ASCA= Saccharomyces Cerevisiae)
God, damnit Mcgowen put you in a breakout room with just the two of you and she shows you CT and says this is a “string sign”. What is disease process is she referring too?
CD
Lead pipe= UC
Describe Crohn’s Disease
RLQ pain (mimics Appendicitis) ASCA + Diarrhea Skip lesions Can spare the rectum Risk of gallstone/kidney stones
How are fistulas named?
Where they started to wear they end (Colovesical= Colon –> bladder)
Describe Ulcerative Colitis
Diffuse Abd pain (left-sided) ANCA + ALWAYS INVOLVE THE RECTUM (my personal motto) Dysentery (bloody diarrhea) Bright red blood on DRE Complications: Toxic MC, perf, cancer
What are three other findings associated with UC?
Pyoderma Gangernosum
Aphthous Ulcers
Erythema Nodosum
A patient has pseudo polyps on colonoscopy, and you’re asked what this rules out?
Crohn’s (cobblestoning) think both start with C
A patient walks into the ER panicking, clutching their stomach, and runs into the bathroom. You walk in and it looks like Tanner/Christian’s murder suicide by dull knife (very bloody). The patient does a line of cocaine and reports ULQ. What is a likely diagnosis?
Ischemic Colitis
- Sudden onset of defecation, hematochezia, thumb-printing on XR.
- Old people= atherosclerosis
- Young people= vaso-occlusive drug use (cocaine)
- Happens at splenic flexure because it has poor perfusion
What are the two diseases that show thumb printing on XR?
Ischemic Colitis
Mesenteric Ischemia
What disease process is associated with Retinal Hypertrophy?
Familial Adenomatous Polyposis (FAP)
What is the recommended treatment for FAP?
Complete proctocolectomy with ileoanal anastomsis before age 20.
Describe Lynch Syndrome
aka: HNPCC
Early onset colon cancer that is INHERITED and ASSOCIATED with multiple cancers
MLH1, MSH2 defects
What is the oral presentation difference between Peutz-Jeghers and Cowden Dz?
Both are hamartomatous polyposis syndromes
PJS: telangiectasis on lips
Cowden: Trichilemmomas on lips (uglier because Cows are ugly)
When do you recommend screening for colorectal cancer in an individual with no family history, and when can you stop screening?
45-75
