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GI Week 6 > Lower GI Bleeding > Flashcards

Lower GI Bleeding Flashcards

1
Q

What percentage of lower GI bleed is actually from an upper GI source? Why is this important?

A

10%

important becaus eyou definitely don’t want to miss it - upper GI bleeds become hemodynamically unstable very rapidly

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2
Q

What percentage of lower GI bleeding is form a colonic source? Small bowel source?

A

colonix - 85%

small bowel - 5%

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3
Q

What are the main causes of small bowel bleeding?

A
  1. angioectasia
  2. ulcers
  3. IBD
  4. infecitons
  5. aortoenteric fistula
  6. diverticular hemorrhage (butt hat would usually be colon)
  7. Meckel diverticulum - especially in an adolescent!!
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4
Q

What are the main cuases of colonic bleeding?

A
  1. diverticular hemorrhage - 30 to 50%
  2. angiodysplasia 20-30%
  3. ischemia
  4. postpolypectomy
  5. neopaslm
  6. IBD
  7. infection
  8. radiation colitis (hx)
  9. anorectal disorders
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5
Q

Why do diverticuli form?

A

there are penetrating blood vessels that travel through the sera into the submucosa. this creates a natural weakness in the wall which allows the bowel layers to pop out under times of continuous high pressure (from low fiber diet)

this is why diverticuli won’t form in the rectum- the blood pattern is different

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6
Q

What part of the GI tract is most commonly affected by diverticuli?

A

sigmoid alone - 65%
sigmoid and another colonic segment - 30%
cecum - 7%

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7
Q

What percentage of people over 85 will have diverticulosis?

A

85%

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8
Q

What percentage of people with diverticulosis will have symptoms of either diverticulitis or hemorrhage?

A

20%

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9
Q

What are the symptoms and complications of diverticuli?

A

pain, diarrhea, fever and abdominal tenderness
hemorrhage is rare

complications include abscess, rupture or fistulas to adjacent organs

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10
Q

What imaging modality is used for diagnosis of diverticulitis?

A

CT (not endoscopy or barium enema)

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11
Q

If you have mild diverticulitis without peritoneal signs, wha tis the treamtent/

A

oral hydration, liquid diet, 10 days of oral antibiotics

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12
Q

If you have severe pain, are elderly with comorbidities or can’t take food orally, wha tis the treatment?

A

hospitalizaiton, IV antibiotics, NPO, and CT for further complications

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13
Q

What percentage of lower GI bleeding is caused by acute diverticular hemorrhage?

A

50%

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14
Q

True or flase: the hemorrhage from acute diverticuli hemorrhage is self limited in only 10% of cases.

A

false - in 80%

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15
Q

True or false: bleeding from acute diverticular hemorrhage almost always recurrs, so surgery is typically needed.

A

false - it only recurs in 1/3 of patients

but if you do have a recurrence, you’re very likely to have another recurrence, so then you do surgery

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16
Q

Describe management of diverticular hemorrhage?

A
  1. resuscitation
  2. reverse anticoagulation
  3. transfuse if necessary
  4. consider/exclude upper GI bleed
  5. observe, since most are self limited
  6. colonoscopy if it persists with the options of epinephrine, clips , cautery and bands for treatment

may require surgery

17
Q

What is anioectasia/angiodysplasia?

A

when there is a tortuous, dilated submucosal capillary/vein network that lacks any small muscle (weak)

they’re spider like and can occur anywhere, but usually the right colon

18
Q

How do the angioctasias present/

A

overt hemorrhage or anemia

19
Q

What percentage of angioectasias will rebleed without endotherapy?

A

80%

20
Q

What are the three associated “comorbidities” for angioectasia?

A

aortic stenosis (Heyde’s syndrome)

chronic renal failure

advanced age

21
Q

What is the treatment for angiodysplasia?

A

colonoscopy with ablation using argon plasma, cautery or hemoglips

if that doesn’t work, may need to do a subtotal colectomy

22
Q

What are the three general causes of colitis that can contrbute to lower GI bleeding?

A
  1. inflammatory (Crohns, UC and NSAIDS)
  2. infections (salmonella, shigella, campylobacter, E coli)
  3. ischemica
23
Q

How does ischemic colitis present?

A

usually acute, severe abdominal pain followed by self-limited hematochezia (passing of bright red blood - lots of it)

may have mild to moderate focal tenderness, fever, WBC elevation and ielus

24
Q

True or false: ischemic colitis almost always as complications like stricutres or perforation down the ine.

A

false - most are without complications and resolve completely

25
Q

Wher ein the colon is ischemic colitis most likely to occur?

A

left splenic flexure because it only receives a limited blood supply from the IMA

the right colon is much less likely to be involved because it receives many anastomoses form the SMA

26
Q

So which would be worse - left sided ischemic colitis or right sided ischemic colitis?

A

definitely right sided - it’s a whole different beast

27
Q

What will you see on CT in ischemic colitis?

A

a thickened colon wall

28
Q

In speaking about neoplasm….right colon neoplasia is most likely to present with ____ while left colon neoplasia is more likely to present with _____

A 
right = anemia
left = obstruction (because it's narrower)

but both can present with occult, slow bleed, or anemia, rarely hematochezia

29
Q

What are the two general types of radiation proctitis?

A

acute radiation proctitis (with tenesmus, diarrhea, pain, rarely bleeding)

chronic radiation proctopathy (anemia, hematochezia months oryears after the radiation)

30
Q

What’s the treatment for radiation proctitis/

A

endoscopic ablation of the areas with argon

used to use formaldehyde, SCFA enemas and steroids, but not much anymore

31
Q

What is an anal fissure? WHere does it usually occur?

A

It’s an acute or chronic tear in the anal canal - usually on the posterior wall

32
Q

How will an anal fissure present?

A

pain and bright blood with stool passage

in acut einstances, people can often pin point the exact onset

33
Q

What are the common causes/comorbidities of anal fissures?

A

constipation (strainign)
diabetes
crohn’s disease

34
Q

What is the treatment for an anal fissure?

A

stool softening and bulking with fiber
topical nitrates and calcium channel blockers to inhibit internal sphincter spasms, (which make it worse)
lateral sphincterotomy
sphincter dilation (almost never)

35
Q

What is a hemorrhoid?

A

a dilated plexus of submucosal middle and superior hemorrhoidal veins

36
Q

What are the symptoms of a hemorrhoid?

A

bleeding, pruritis, pain if thrombosis

37
Q

What is the peak incidence for hemorrhoids?

A

45-60; it’s rare in those under 20

38
Q

What are the risk factors for hemorrhoids?

A

advancing age, diarrhea, pregnancy, prolonged sitting, straining and chronic constipation

39
Q

What is the treatment for hemorrhoids?

A

stool softening and bulkig with fiber

banding or hemmorrhoidectomy

GI Week 6 (14 decks)

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