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MBBS 3: Surgery > Lower GIT Bleeding > Flashcards

Lower GIT Bleeding Flashcards

1
Q

What is lower GI bleeding?

A

Bleeding that occurs distal to the ligament of Treitz
Note:
Normal fecal blood loss 1.2ml / day
Significant - > 10ml/ day
- Range from scant bleeding to massive hemorrhage

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2
Q

Incidence?

A

20-30% of episodes of GI hemorrhage
- Incidence rises steeply with age

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3
Q

Common source of lower GI bleeding?

A

colon
> 80 - 85% originate distal to ileocecal valve
> Only 0.7% to 9% originate from small intestines
Note:
80 % LGIB resolve spontaneously
- 20% will re-bleed

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4
Q

Presentation?

A
  1. Hematochezia
    blood passing from rectum to anus
    - Range from bright-red blood to old clots
  2. Melena
    Black, tarry stools
    - Bleeding is slower or from a more proximal source
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5
Q

Categorisation?

A

intensity
1. Massive bleeding
2. Moderate Bleeding
3. Occult Bleeding

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6
Q

Presentation of massive bleeding?

A

Presents as large volume of bright red blood PR
- Bleeding > 1.5L/day

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7
Q

Signs and symptoms of massive bleeding?

A
  1. Hemodynamic instability and shock
  2. ↓ hematocrit level of 6g/dl or less
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8
Q

Treatment for massive bleeding?

A

Transfusion of at least 2 units of packed red blood cells/whole blood

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9
Q

Common causes of massive bleeding?

A

Common causes – D/A

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10
Q

Epidemiology of massive bleeding?

A

Massive hemorrhage common in patients > 65 yrs with multiple medical problems

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11
Q

Presentation of moderate bleeding?

A
  1. hematochezia
  2. malena
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12
Q

Sign and symptoms of moderate bleeding?

A
  1. Hemodynamically stable
  2. Initial ↓in hematocrit level of 8g/dL or less
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13
Q

Describe occult bleeding?

A
  • Occurs in the absence of overt bleeding and identified on lab test
  • Detected by routine chemical tests of the stool, with or without systemic evidence of chronic blood loss
    > Investigating for Iron deficiency anaemia
  • 10ml. of blood loss is necessary to have stool occult blood positive
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14
Q

Inflammatory aetiology?

A
  1. Ulcerative colitis
  2. Crohn’s disease
  3. infective colitis
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15
Q

Vascular aetiology?

A
  1. Ischemic colitis
  2. angiodysplasia
  3. hemangioma
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16
Q

Neoplastic aetiology?

A
  1. Adenoma
  2. carcinoma
  3. polyps
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17
Q

Clotting disorder aetiology?

A
  1. Hemophilia
  2. Warfarin therapy Leukemia
  3. DIC
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18
Q

Congenital aetiology?

A
  1. Polyp
  2. Meckel’s diverticulum
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19
Q

Miscellaneous aetiology?

A
  1. Hemorrhoids
  2. anal fissure
  3. injury to rectum
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20
Q

What is an anal fissure?

A

Tear in the lining of the rectum caused by passage of hard stools

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21
Q

Signs and symptoms of an anal fissure?

A

Sharp knife-like pain and bright red rectal bleeding with bowel movements

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22
Q

Management of anal fissure?

A

Medical :
1. stool bulking agents
2. ↑water intake
3. stool softeners
4. topical nitroglycerin ointment or diltiazem to relieve sphincter spasm and promote healing

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23
Q

What are hemorrhoids?

A

Cushions of submucosal tissue containing venules, arterioles and smooth muscle fibres located in anal canal

24
Q

Location of hemorrhoids?

A
  1. left lateral
  2. right anterior
  3. right posterial
25
Function of hemorrhoids?
act as part of continence mechanism aid in complete closure of anal canal at rest - Normal part of anorectal anatomy Note: Rx required if symptomatic
26
Risk factors for hemorrhoids?
1. excessive straining 2. ↑abd pressure 3. hard stools Note: can cause painless bright red rectal bleeding with bowel movements
27
Types of hemorrhoids?
1. External - distal to dentate line - covered with anoderm 2. Internal - proximal to dentate line - covered by anorectal mucosa > Prolapse and bleed > Rarely painful unless thrombosis & necrotic, severe prolapse incarceration and/or strangulation
28
How do you grade hemorrhoids?
extent of prolapse 1. 1st degree - no prolapse, just prominent vessels 2. 2nd degree - prolapse (come out) with strain but spontaneously reduce (go back in) 3. 3rd degree - prolapse with strain and have to be pushed back in 4. 4th degree - prolapsed out and cannot be reduced or pushed back in
29
Management of hemorrhoids?
1. Dietary fibre 2. Stool softner 3. ↑ fluid intake 4. Avoidance of straining 5. Dietary fibre 6. Stool softner 7. ↑ fluid intake 8. Avoidance of straining
30
What is Hemorrhoidectomy?
Required for large, symptomatic, combined hemorrhoids
31
Inflammatory bowel disease?
1. Ulcerative colitis 2. Crohns Disease 3. Indeterminate colitis
32
Incidence of IBD?
Common in US, Northern Europe Incidence lower : Africa, Asia, South America Common in the 3rd and 7th decade
33
Causes of IBD?
1. Environment 2. genetic 3. immunological/multifactorial
34
Presentation of IBD?
Characterized by intestinal Inflammation
35
What is Ulcerative colitis?
36
Mucosal ulcerative colitis?
- colonic mucosa and sub-mucosa are infiltrated with inflammatory cells - Mucosa may be atrophic, crypt abscesses are common
37
Endoscopic ulcerative collitis?
mucosa is frequently friable and may possess multiple inflammatory pseudocyst
38
Long standing colitis?
colon is foreshortened and mucosa replaced by scar
39
Ulcerative colitis may affect what?
1. Rectum – Proctitis 2. Rectum & sigmoid – proctosigmoiditis 3. Rectum & Left colon – Left sided colitis 4. Rectum & varying length of colon (extending proximal to splenic flexure) – pancolitis
40
Signs and symtoms?
Symptoms related to - degree of mucosal inflammation, extent of colitis
41
Typical presentation of ulcerative colitis?
1. bloody diarrhea 2. crampy abdominal pain
42
Proctitis?
tenesmus `
43
Fulminant colitis?
severe abd pain and fever
44
Physical findings in ulcerative colitis?
range from minimal abd tenderness to frank peritonitis
45
Diagnosis of ulcerative colitis?
colonoscopy and mucosal biopsy 1. U/C key feature : involvement of rectum & rectum 2. Rectal sparing or skip lesions : Crohn’s disease
46
What is Crohns Disease?
Trans mural inflammatory disease Affect any part of GI: mouth to anus - Chronic inflammation → fibrosis, stricture & fistula → colon/small intestines
47
Pathologic findings of Crohns disease?
1. mucosal lacerations 2. inflammatory cell infiltrates 3. noncaseating granulomas
48
Endoscopic appearance of Crohns disease?
1. Deep serpiginous ulcer 2. “cobblestone” appearance 3. Skin lesions 4. Rectal sparing
49
Symptoms of Crohns disease?
depend on severity of inflam. and/or fibrosis & location of inflammation 1. Acute inflammation - bloody diarrhea, crampy abd pain, fever 2. Stricture - symptoms of obstruction 3. Weight loss from obstruction + protein loss 4. Perianal Crohn’s - pain, swelling and drainage from fistulas/abscesses
50
What is infective colitis?
Pseudomembranous colitis caused by C. difficile ( gram –ve anaerobic bacillus)
51
Presentation of infective colitis?
1. diarrhea (bloody or non-bloody) 2. crampy abd pain, 3. malaise
52
Stool analysis for infective colitis?
identify microorganism
53
What is diverticular disease?
outpouchings that project from the bowel wall - Their development is caused by decreased fibre diet.
54
Diverticulosis?
presence of diverticular without inflammation
55
Diverticulitis?
Inflam. & infection associated with diverticular

MBBS 3: Surgery (42 decks)

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