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Flashcards in GI CIS Deck (67)
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1

Describe type of bleeding associated with hemorrhoids

Painless bleeding, usually associated with BM, coats the stool at end of defecation. Blood may drip into toilet or stain toilet paper

2

Describe type of bleeding associated with anal fissures

Small amount on toilet paper or surface of stool; usually dx on history of tearing pain with passage of BM

3

Describe type of bleeding associated with diverticula

Painless, profuse bleeding

4

Which is more likely to exhibit hematochezia — UC or crohns?

UC

5

Describe presentation of infectious colitis

Similar clinical presentation and endoscopic appearance of UC; excluded with stool and tissue cultures, stool studies, and on biopsies of the colon (EHEC)

6

What condition may present as abdominal pain followed by profuse hematochezia?

Ischemic colitis

7

T/F: polyps are typically symptomatic and result in intermittent large amounts of bleeding

False, they are typically asymptomatic and most often detected by colon cancer screening tests as occult bleeding

8

Describe type of bleeding associated with proctitis

Insidiously with intermittent rectal bleeding, passage of mucus, and mild diarrhea associated with fewer than 4 small loose stools per day (like mild UC)

9

Describe type of bleeding associated with rectal ulcers

Can present with bleeding, passage of mucus, straining during defecation, and sense of incomplete evacuation

10

Important hx and PE points to ask/perform on GIB patient

Prior episodes of GI bleeding?
Chance of pregnancy in females
PMH of IBD, cancer, CV dz, diverticulosis, PUD
Medications — ask about NSAIDs, ACs, antiplatelet agents

PE: assess hemodynamic stability, general exam, CV, skin, abdominal, DRE

11

How is smoking related to IBD?

Stopping smoking is risk factor for UC

Starting smoking is risk factor for Crohns, continued smoking = poorer prognosis

12

BUN:Cr ratio seen in upper GIB

30:1

13

AST:ALT ratio in alcoholic

2:1

14

Anatomical division of an upper GIB vs lower GIB

Ligament of Treitz

15

Recognize what abruptly stopping a beta blocker can lead to

Rebound sinus tachycardia

16

How fast can KCl be given through a peripheral IV?

10 mEq/hr (otherwise it is irritating the vein)

17

How many g/dL would you expect the Hgb to rise from 1 unit of PRBCs?

1g/dL

18

Primary tx for acute IBD flare

Corticosteroids (IV or PO)

19

Condition often seen with IBD characterized by red nodular areas on shins

Erythema nodosum

20

Initial management of acute lower GIB

Supportive: IV access, admit to appropriate setting, O2, IVF, blood products, assessment/management of coagulopathies

In cases of ongoing bleeding or high risk features: colonoscopy should be done w/i 24 hours of presentation after adequate colon prep (typically 4-6 L polyethylene glycol — may require NG tube)

21

Considerations for blood transfusion with PRBCs (type and screen vs. type and cross), what are Hgb requirements of special pt populations?

First type and screen in Hgb is stable and no acute bleed

Type and cross for young pts without comorbidities (may not require transfusion until Hgb <7), older pts who have severe comorbid conditions like CAD require Hgb of >9

Obtain iron studies if desired BEFORE transfusion, otherwise inaccurate

22

T/F: pts with active bleeding and hypovolemia may require transfusion even if they have a normal Hgb

True

23

Diagnostic test for GIB that is noninvasive, sensitive to low rates of bleeding, and can be repeated for intermittent bleeding, BUT it has to be performed during active bleed, has poor localization, not therapeutic, and not widely available

Radionuclide imaging

24

Diagnostic test for GIB that is noninvasive, accurately localizes bleeding source, provides anatomic detail, and is widely available; BUT it has to be performed during active bleeding, is not therapeutic, and may require IV contrast+radiation exposure

CT angiography

25

Diagnostic test for GIB that accurately localizes bleeding source, therapy possible with super-selective embolization, and does not require bowel prep; BUT has to be performed during active bleeding and has potential for serious complications

Angiography

26

Pros and cons to colonoscopy

Pros: precise dx and localization regardless of active bleeding or type of lesion; endoscopic therapy is possible

Cons: need colon prep for optimal visualization, risk of sedation in acutely bleeding pt, definite bleeding source (stigmata) infrequently identified

27

Complications/risks in pts with UC

Toxic megacolon (emergency — surgery for colectomy)

Primary sclerosing cholangitis (M>F)

Ankylosing spondylitis

Pyoderma gangrenosum

28

Complications/risks in crohns

Fistulas/strictures

Fissures

Pigmented gallstone formation

Malabsorption

Kidney stones

29

Complications seen with BOTH UC and crohns

Colon cancer, DVT

30

Signs of retroperitoneal hemorrhage on PE

Cullen sign — periumbilical ecchymosis

Grey turner sign — flank ecchymosis