Melena and Hematochezia DSA Flashcards

1
Q

How does an UGIB typically present? LGIB?

A

a. melena (if rapid, can be hematochezia)
b. hematochezia

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2
Q

When is a bleed defined as LGIB?

A

when it is distal to the ligament of Treitz

*LGIBs are less likely than UGIB to present with shock, orthostasis, or to require transfusions

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3
Q

Alcohol use can cause what type of varices?

A

esophageal (UGIB)

colonic (LGIB)

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4
Q

What medications can cause a GIB?

A
  • 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

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5
Q

What treatment is done for both upper and lower GIBs? Specifically for UGIB?

A
  1. Stabalize, two large bore IVs, fluid bolus (if in shock), blood tranfusion (if needed), labs (cbc, chem profile…)
  2. PPI, Ocretoide (varices - inhibits gastric acid secretion, dec BF to gastroduodenal mucosa, splanchnic vasoconstriction), ABs (if variceal bleed)
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6
Q

What is the etiology of diverticulosis?

A

unknown - possibly low fiber diet or increaed intraluminal P

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7
Q

What is diverticulosis?

A

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

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8
Q
A
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9
Q

What disease is associated with lead pipe colon? cobblestoning? fat wrapping?

A

lead pip - UC

fat wrapping, cobblestoning - CD

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10
Q

How do UC pts present? CD?

A

a. rectal bleeding, bloody diarrhea, left sided abd pain, tenesmus, wt loss
b. N/V, diarrhea, RLQ abd pain, wt loss, acute ileitis

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11
Q

What is a shared and feared complication of UC and CD?

A

colon CA

increased risk with long duration of disease, FH, extensive disease, PSC, strictures, post inflamm pseudopolyps

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12
Q
A
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13
Q

What is seen in 70% of pts with UC? 60-70% of pts with CD?

A

a. UC - serum ANCA
b. CD - antibodies to Saccharomyces cerevisiae (ASCA)

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14
Q

What is a lead pipe sign? string sign?

A

a. loss of haustra in UC
b. narrowing from inflammation or stricture in CD

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15
Q

What imaging is better for CD pt pelvic lesion concerns?

A

MR > CT

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16
Q

How do you treat CD?

A

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)

17
Q

List the types of CD fistulas

A
18
Q

Which IBD has a better outcome with surgery?

A

UC - can be curative

19
Q

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?

A

ischemic colitis

20
Q

What might acute mesenteric ischemia be confused with and why?

A

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

21
Q

What is the cause of anal fissures?

A

trauma during defecation

leads to linear or “rocket shaped” ulcers usually less than 5mm

22
Q

What organisms can cause anorectal infections?

A

Neisseria gonorrhorea

Treponema Pallidum

Chlamydia Trachomatis

Herpes Simplex Type 2

Condylomata Acuminata - Anal Conylomas (HPV)

23
Q

Who is a risk for anal cancer?

A

F > M

homosexual men are at increased risk

24
Q

What are the four groups of polyps?

A
25
Q

What can be present at birth to indicate FAP?

A

congenital hypertrophy of the retinal pigment epithelium

26
Q

What mutations are seen in FAP?

A

90% - APC - AD

8% - MUTYH - AR

15% - sporadic

27
Q
A
28
Q

What are the guidelines for colorectal cancer screening (average risk)?

A
29
Q

What is the most useful method of diagnosis of Meckel’s?

A

technetium - 99m scan