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FAMILY MEDICINE > Lower GI Bleeding > Flashcards

Flashcards in Lower GI Bleeding Deck (30):
1

Common symptoms of anemia

weakness, easy fatigability, pallor of conjunctivae/skin, chest pain, dizziness, tachycardia, hypotension,, orthostasis

2

Risk factors for presenting in shock in the setting of lower GI bleed

older patient, comorbidities such as CAD

3

T/F: hematochezia always means lower GI bleed

FALSE. Can also be seen in patients with heavy upper GI bleed

4

How to definitively differeniate between lower and upper bleed

nasogastric aspriate

aspirate that shows bile not blood = lower GI source of bleeding

5

If patient isn't HDS...

TRANSPORT IMMEDIATELY TO ER.

6

Test of choice for determination of lower GI bleedng source

colonoscopy

7

alternatives to colonoscopy if unavailalbe

angiography, technetium labeled colloid, sigmoidoscopy (if negative -> colonoscopy, then if both negative -> panendoscopy)

8

Most common sources of lower GI bleeding

hemorrhoids > colorectal polyps > diverticulosis > colorectal cancer > ulcerative colitis (UC) > AVM > colonic stricture

9

"internal" vs "external" hemorrhoids

internal = above dentate line
external = below dentate line

10

Risk factors for hemorrhoids (dilated vessels in anus)

chronic constipation, straining during BM, pregnancy, prolonged sitting (i.e. truck drivers)

11

conservative treatment for hemorrhoids

high fiber diet, stool softeners, precautions against prolonged straining

12

outpouchings of colonic mucosa through weakened areas of colon wall

diverticula

13

why are diverticula so hard to diagnose?

often asymptoatic and must be found on endoscopy/bowel imaging studies...painless bleeding usually

14

Risk factors that increase diverticular bleeding

aspirin or NSAID use

15

how to treat asymptomatic and symptomatic diverticular bleeding

asymptomatic - high fiber diet
symptomatic - may need to resect affected area of colon

16

presentation of diverticulitis

LLQ pain, fever, nausea, diarrhea/constipation

17

complications of diverticulitis

perforation and/or intraabdominal abscess cor pertonitis

18

How to treat diverticulitis

bowel rest plus antibiotics (combo of quinolone and agent for anaerobes like metronidizole)

if perf...SURGERY

19

CONTINUOUS inflammation of large bowel starting from rectum and extending proximally

UC

20

areas of focal inflammation, can occur anywhere in GI tract

crohn's disease

21

Symptoms of IBD

recurrent episodes of abdominal pain, diarrhea, weight loss, rectal bleeding, fistulas, abscesses

22

Extraintestinal manifestations of IBD

arthritis (most common), sclerosing choloangitis, cirrhosis, fatty liver, pyoderma gangrenosum, erythema nodosum

23

UC is major risk factor for

development of colon cancer

24

Symptomatic therapy for IBD

antidiarrheal meds, immunosppresive meds, anti inflammatory meds

25

Which IBD can be treated definitely with surgery and when to do this?

UC with total colectomy...reserve for pancolitis, failure to respond to medical therapy, or because of colon cancer risk

26

adenmatous polyps

benign growths that have a potential to become malignant

27

list adenomatous polyps in order of potential for becoming cancerous (name three)

tubular adenoma, tubulovillous adenoma, villous adenoma

28

Any patient older than 50 with lower GI bleeding must be evaluated for...

colon cancer

29

when to start screening for colon cancer

age 50 or younger if they have increased risk (family history, UC, hx of polyps)

30

Lower GI bleeding vs upper GI bleeding

lower is distal to ligament of treitz (b/w duodenum and jejunem)