Lower GIB

Question 1

Lower GI bleed involves a source where?

Answer 1

Distal to Ligament of Treitz

Question 2

Most common sign of a LGIB?

Answer 2

Hematochezia = bright red blood in stool

Question 3

Differential diagnoses of LGIB depend on what 2 things?

Answer 3

Age of patient

Severity of bleeding

Question 4

What things can stimulate Hematochezia?

Answer 4

NSAIDs, Anticoagulants, liquid medication with red dye

Beets, Red Kool-aid

Question 5

Co-morbid conditions?

Answer 5

IBD

Liver/renal/diverticular disease

Question 6

10% of hematochezia conditions are due to what type of bleed?

Answer 6

UPPER GI bleed

Question 7

90% of hematochezia conditions are due to what type of bleed?

Answer 7

Lower GI bleed

Question 8

4 common differential diagnoses for a LGIB?

Answer 8

Diverticulosis
IBD
Ischemic Colitis
Intussusception

Question 9

4 common differential diagnoses for a LGIB?

Answer 9

Diverticulosis
IBD
Ischemic Colitis
Intussusception

Question 10

Diverticulosis

Answer 10

Sac-like protrusions of mucosa through the muscularis due to increased intraluminal pressure

Question 11

Most common location for Diverticulosis?

Answer 11

Sigmoid colon

Question 12

Symptoms of Diverticulosis?

Answer 12

PAINLESS, large-volume hematochezia in older patients

Question 13

Many patients with Diverticulosis describe have ____ history with colonoscopy

Answer 13

Normal

– usually asymptomatic

Question 14

Diagnostic test to do for Diverticulosis once the bleeding stops?

Answer 14

Colonoscopy

Question 15

Diverticulitis vs. Diverticulosis?

Answer 15

Diverticulitis = NO hemorrhage
Diverticulosis = Large volume Hematochezia (painless)

Question 16

Painless hematochezia in elderly patients with an asymptomatic history could be?

Answer 16

Diverticulosis

Question 17

2 types of IBD?

Answer 17

Crohn Disease

Ulcerative Colitis

Question 18

Crohn Disease - correlation with smoking?

Answer 18

Usually onset of Crohn’s correlates with new onset of cigarette smoking

Question 19

Symptoms of Crohn Disease?

Answer 19

Fever, RLQ pain (mimics appendicitis), diarrhea

Question 20

Why does Crohn Disease present with RLQ pain?

Answer 20

Ileum is most commonly affected (ileitis)

Question 21

Abscesses, strictures, fistulas are all common with?

Answer 21

Crohn Disease

Question 22

For Crohn Disease, serum ___ will be (+)

Answer 22

ASCA

Question 23

What sign will be (+) with enema for Crohn Disease?

Answer 23

String sign - due to narrowing of lumen

Question 24

Possible complications with Crohn Disease?

Answer 24

Colon cancer
Gall/kidney stones
Bile salt malabsorption - secretory diarrhea

Question 25

Is surgery suggested for Crohn Disease?

Answer 25

ONLY if absolutely necessary for complications | -- can make Crohn Disease worse!

Question 26

Is perinanal disease common with Crohn Disease?

Answer 26

Yes

Question 27

Ulcerative Colitis - correlation with smoking?

Answer 27

Can correlate with recent cessation of smoking | - smoking is protective against developing it

Question 28

Symptoms of Ulcerative Colitis?

Answer 28

Bloody diarrhea, fecal urgency and cramps relieved by defecation - LLQ pain

Question 29

Bloody diarrhea with cramps that are relieved by defecation can suggest?

Answer 29

Ulcerative Colitis

Question 30

For Ulcerative Colitis, serum ___ will be (+)

Answer 30

ANCA

Question 31

ANCA (+)

Answer 31

Ulcerative Colitis

Question 32

ASCA (+)

Answer 32

Crohn Disease

Question 33

What sign will be positive with Ulcerative Colitis?

Answer 33

"lead pipe colon" = loss of haustra

Question 34

Possible complications of Ulcerative Colitis?

Answer 34

Colon cancer | Toxic megacolon, sclerosing cholangitis

Question 35

Is surgery suggested for Ulcerative Colitis?

Answer 35

Yes - not first line of treatment though

Question 36

2 common extra-intestinal manifestations of Ulcerative Colitis?

Answer 36

Pyoderma gangrenosum | Ankylosing spondylitis

Question 37

Pyoderma gangrenosum and ankylosing spondylitis can be seen with?

Answer 37

Ulcerative Colitis

Question 38

Common PMH item with Ischemic Colitis?

Answer 38

Atherosclerosis

Question 39

Symptoms of Ischemic Colitis?

Answer 39

Cramping lower abdominal pain and passage of bloody stool

Question 40

What does the X-ray show with Ischemic Colitis and why?

Answer 40

Thumb-printing | - hemorrhage causes colonic wall thickening

Question 41

What does a Sigmoidoscopy show with Ischemic Colitis?

Answer 41

Friability and submucosal hemorrhage | - risk of perforation due to free air under diaphragm

Question 42

Telescoping bowel

Answer 42

Intussusception

Question 43

What will be seen on imaging with Intussusception?

Answer 43

Bull's eye

Question 44

Symptoms of Intussusception?

Answer 44

Common in kids = Colicky abdominal pain - - jelly like stool?

Question 45

Symptoms of Intussusception?

Answer 45

Common in kids = Colicky abdominal pain - - jelly like stool?