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Flashcards in GI High Yield HO Deck (71)
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1

differential dx for hematochezia

hemorrhoids
anal fissures
diverticular bleed
IBD
infectious colitis
ischemic colitis
AV malformation
rapid upper GIB
polyps
rectal ulcers
colorectal cancer
radiation colitis

2

painless bleeding associated with bowel movement, coats the stool at the end of the defecation. blood may also drip into the toilet or stain toilet paper

hemorrhoids

3

dx from the hx, tearing pain with the passage of bowel movements, a small amount on the toiilet paper or on the surface of stool

anal fissures

4

which IBD is more likely to present with hematochezia

ulcerative colitis

5

hematochezia developed weeks to years after abdominal or pelvic irradiation

radiation colitis

6

what are important history and physical points to ask/perform on a GIB patient

prior episodes of GI bleeding?
pregnancy?
hx of IBD, cancer, CV disease, diverticulosis, PUD
medications - NSAIDS, anticoagulants, antiplatelets
PE - assess hemodynamic stability - look for signs of hypovolemia
general exam - CP, skin, abdominal, DRE

7

signs of hypovolemia include

mild to moderate hypovolemia will present with resting tachycardia
15% blood volume loss - orthostatic hypotension (decrease in systolic of more than 20 mmhg and/or increase in HR of 20bpm when moving from recumbency to standing)
40% decrease - supine hypotension

8

medications of interest in GIB patients

NSAIDS
anticoagulants
antiplatelets

9

ulcerative colitis assocation with smoking

stopping smoking is a risk factor for UC

10

crohn disease assocaition with smoking

starting smoking can induce flare or first episode
continued smoking leads to a poorer prognosis

11

bun:cr ratio in upper GIB patients

30:1

12

ast:alt ratio in an alcoholic

2:1

13

anatomical division between the upper GI and lower GI

ligament of trietz

14

pt abruptly stops using a beta blocker -- what are they at risk of developing

rebound sinus rhythm

15

what dx study should be performed in any femal of child-bearing age with abdominal pain?

pregnancy test

16

fastest rate K can be given in a peripheral IV

10mEq/hour
otherwise it is irritating

17

how many g/dl would you expect hemoglobin to rise after infusing 1 unit of PRBCs

1 unit should raise Hgb by 1g/dL

18

primary tx for acute IBD flare up

corticosteroids
IV or PO

19

red nodular areas on the shins seen in many inflammatory conditions

erythema nodosum

20

initial management of an acute lower GIB

supportive: IV ccess, appropriate setting (outpatient/inpatient/ICU) O2, IVF, blood products, assessment and management of coagulopathies
in patients with ongoing bleeding or high risk clinical features
colonoscopy w/in 24h

21

before recieving a colonoscopy, what should be patients be adminsitered

4-6L of PEG

22

if patient presenting with a subacute GIB has a stable
but low hemoglobin, how should you manage

type and screen

23

at what hemoglobin level do young patients without cormorbid illness recieve transfusion

< 7 g/dL

24

at what hemoglobin level do older patients with comorbid illnesses such as CAD require transfusion

<9 g/dL

25

before transfusing any PRBCs, what lab test should you perform?

iron studies
otherwise they will be inaccurate

26

pros to radionuclide imaging

noninvasive
sensitive to low rates of bleeding
can be repeated for intermittent bleeding

cons - has to be performed during active bleeding
poor localization of bleeding site
not widely available

27

pros to CT angiography

noninvasive
accurately localizes bleeding source
provides anatomic detail
widely available

cons - has to be performed during active bleeding
not therapeutic
radation and IV contrast exposure

28

pros to angiogrpahy

localization
therapy w/ super selective embolization
does not require bowel prep

cons
active bleeding
potential for serious complicatiosn

29

pros to colonoscopy

precise dx and therapeutic
endoscopic therapy is possible

cons - need to prep colon - risk of sedation in acutely bleeding patient
definite bleeding source infrequently IDd

30

patients with UC are at an increased risk for what complications?

toxic megacolon
PSC
ankylosing spondylitis
pyoderma gangrenosum

colon cancer and DVT