GI CIS high yield handout 2

Question 1

procedures used for evaluation of lower GIB

Answer 1

radionuclide imaging
CT angiography
angiography
colonoscopy

Question 2

iscehmic colitis

Answer 2

abdominal pain followed by profuse bleeding

Question 3

poderma gangrenosum

Answer 3

UC

Question 4

infectious colitis

Answer 4

similar clinical presentation and endoscopic appearance to UC, excluded with stool and tissue culture, stool studies, and on biopsies of colon

Question 5

ankylosing spondylitis

Answer 5

UC

Question 6

during an acute IBD flare, what is the primary treatment

Answer 6

corticosteroids

Question 7

proctitis

Answer 7

insidiously with intermittent rectal bleeding, passage of mucus, and mild diarrhea associated with fewer than four small loose stools per day

Question 8

initial managment of acute lower GIB in pts with ongoing bleeding or high-risk clinical features

Answer 8

colonscopy witin 24 hours presentation after colon prep to improve diagnositc and therapeutic yield
-adeqyete bowel prep need 4-6 liters of polyethylene glycol
NG tube may help with getting prep down

Question 9

pigmented gallstone formation

Answer 9

CD

Question 10

pts with active bleeding and hypovolemia may require what

Answer 10

blood tranfusion despite apparently normal hemoglobin

Question 11

what is the Bun:Cr ration in an upper GIB

Answer 11

30:1

Question 12

colon cancer

Answer 12

CD and UC

Question 13

rectal ulcers can present with

Answer 13

bleeding, passage of mucus, straining during defecation, and a sense of incomplete evacuation

Question 14

malabsorption

Answer 14

CD

Question 15

ad and disad of CT angiography for lower GIB

Answer 15

ad: noninvasive, localize bleeding source, provides anatomic detail, widely available

disad: has to be performed during active bleeding
not therapeutic, radiation and IV contrast exposure

Question 16

young pts without comorbid illness may not require tranfusion until hemoglobin is

Answer 16

less than 7 g/dL

Question 17

what is the AST:ALT ratio in an alcoholic

Answer 17

2:!

Question 18

what can abruptly stopping a beta blocker lead to

Answer 18

rebound tachy

Question 19

when do you obtain iron studies

Answer 19

before transfusion bc afterwards they are inaccurate

Question 20

older pts and those who have severe comorbid illnesses like CAD require at least

Answer 20

9 g/dL

Question 21

how fast can postassium chloride be given through a peripheral IV

Answer 21

10 mEq per hour

Question 22

angiography advant and disadvant for lower GIB

Answer 22

ad: localize bleeding source, therapy possible, no bowel prep
disad: has to be done during active bleed, potential for serious complications

Question 23

tearing pain with the passage of bowel movements, a small amount on the toilet paper or on the surface of stool

Answer 23

anal fissures

Question 24

DVT

Answer 24

CD and UC

Question 25

painless profuse bleeding

Answer 25

diverticular bleed

Question 26

what diagnositcs should be condsidered when there is concern for upper GI bleeding source

high index
mod suspicion

Answer 26

high index suspicion–> upper endoscopy EGD

moderate suspicion–> NG tube with lavage

Question 27

what is the anatomical division of an upper GIB vs lower GIB

Answer 27

ligament of Treitz

Question 28

consideration for blood transfusion with packed RBC’s

Answer 28

type and screen if hemoglobin is stable and no acute bleed

type and cross

Question 29

initial management of acute lower GI bleed

Answer 29

supportive: IV access, O2, blood products, assessment and managment of coagulopathies

Question 30

how many g/dL would you expect the hemoglobin to raise from 1 unit of packed RBCs

Answer 30

giving 1 unit of PRBC’s should incresae Hgb by 1g/dL

Question 31

signs of hypovolemia

Answer 31

mild to moderate hypovolemia: resting tachy

blood volume loss of at least 15 percetn: ortostatic hypotension

blood volume loss of at least 40%: supine hypotension

Question 32

advantage and disadvantage radionuclide imaging for lower GIB

Answer 32

ad: noninvasive, detects low rate bleeding and can be repeated for intermittent bleeding
disad: has to be performed during active bleeding, poor locatlization, not therapeutic

Question 33

colnocscopy for lower GIB disad and advant

Answer 33

ad: precise diagnosis and locatliztion, endoscopic therapy possible
disad: need colon prep, risk of sedation in acutely bleeding pt, definite bleeding source infreq identified

Question 34

positive UGIB

false neg when

Answer 34

coffee ground material or bright red blood

can be false negative if bleeding stopped or its beyond a closed pylorus (duod bleed)