Small bowel obstruction
Present with obstiption
On CT you will see dilated loops of bowel, air-fluid level, string of pearls or stackmof coins
Tx: NPO, IVF, possible NG tube, surgery
Note: Obstipation is a severe form of constipation where a person is unable to pass stool or gas, resulting in a complete blockage of the bowels.
Red bright GI bleed, how to identify source
Colonoscopy indicated to identify blood source.
If colonoscopy not possible due to instability due a CT angiography of abdomen and pelvis to determine the source of bleeding.
Completing the colonoscopy in the first 14 days has similar outcomes to performing in the first 24 hours. Patients who have had a colonoscopy in the past 12 months may not need repeat testing if bleeding has subsided and a suspected bleeding source, such as diverticulosis, was identified on the prior examination.
Technetium Tc 99-labeled RBC scintigraphy is less preferred to isolate source of bleesing.
Laparoscopy is too invasive and risky, and would not isolate the source of bleeding.
Emergent CT angiography is recommended as first line in patients with hemodynamically significant bleeding.
Routinely performing CT angiography before colonoscopy does not improve mortality.
Celiac disease
In symptomatic patients consuming a gluten-containing diet, serologic testing includes measuring tissue transglutaminase IgA levels and total IgA levels to rule out an IgA deficiency.
Because serologic testing can have low sensitivity, endoscopy is recommended if suspicion for celiac disease is high but serology is negative.
Serology and endoscopy are not accurate in diagnosing celiac disease in people who are already following a gluten-free diet. Testing for HLA DQ2 and DQ8 can be helpful because a negative result rules out celiac disease.
DD for painful and painless rectal bleeding
Painful (could mean abd pain)
Inflammatory bowel disease
Infectious colitis
Hemorrhoids
Ischemic colitis (consider this when pt has other risk vascular diseases)
Painless
Angiodysplasia
AV malformation
Colon cancer
Diverticular bleeding
Post-polypectomy bleeding
Note: IBS does not cause rectal bleeding
