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GI2 E1 > melena and hematochezia > Flashcards

melena and hematochezia Flashcards

clinical (67 cards)

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1
Q

differentiate between the sx of upper and lower GI

A

upper= melena, can present to hematochezia

lower= hematochezia

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2
Q

ddx for pts under 50 yo w lower gi bleed

A

infectious colitis
anal fissures, hemorrhoids
IBD
meckels

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3
Q

ddx for patients over 50 with lower gi bleed

A

malignancy
diverticulitis
angiectasias
ischemic colitis

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4
Q

define the location of a LGIB

A

below the Lig of Treitz (past duodenum part 3)

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5
Q

prognosis of UGIB vs LGIB

A

LGBI is more likely to be benign, less likely to present w shock, 75% spontaneously stop bleeding

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6
Q

serious LGIB is more common in who

A

older men

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7
Q

increased risk of LGIB in patients taking

A

aspirin, other antiplatelets, NSAIDs

multivitamin w iron, peptobismol

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8
Q

LGIB with hx of EtOH abuse

A

colonic varices

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9
Q

increased risk of UGIB in patients taking

A 
aspirin
glucocorticoids
NSAIDs
anticoag
MVI w iron, peptobismol
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10
Q

octreotide consumption can inhibit secretion of ___, reduce ____ to the gastroduodenal mucosa, and cause ____ vasoconstriction in patient with varices

A

gastric acid
blood flow
splanchnic

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11
Q

etiology of diverticulosis, most common location

A

herniations or sac like protrusions of the mucosa at the points of nutrient A penetration

sigmoid colon

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12
Q

most common cause of major LGIB

A

diverticulosis

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13
Q

sx, dx, trx of diverticulosis

A

sx= acute, painless, large volume maroon or red blodd in pts over 50, hemorrhage, but 90% are asx

dx= colonoscopy in stable pts, INR/pt/Ptt, CBC

trx=if uncomplicated, high fiber intake and antichol, hemorrhage, also fluid bolus or blood transfusion as needed

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14
Q

patients with IBD have been shown to have ___ intestinal permeability, and ____ impairment of structure and function

A

increased, irreversible

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15
Q

T cell types and interleukins in crohn vs UC

A

Crohn= Th1 + Th17, TNF/IFN-g, IL17

UC= Th2 type, IL-5, IL-13

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16
Q

UC= L_Q pain and Crohn= L_Q pain

A 
UC= LLQ
Crohn= CRQ
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17
Q

crohn

pattern of lesions
locations of lesions
complications
histo

A

skip lesions, transmural

anywhere in GI trat, discontinuous, mostly in terminal ileus and colon, perianal ds is common

fistulas, strictures, “string sign” on US, bile salt malabsorption, gallstones,

coble-stoning on scope, thickened wall, fat wrapping of colon

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18
Q

ulcerative colitis

pattern of lesions
locations of lesions
complications
histo

A

continuous, superficial

from rectum proximal, not the entire colon

lead pipe sign on xray

loss of haustra, crypt distortion, ulceration, severe hemorrhage, pseudopolyps, toxic megacolon

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19
Q

while smoking is ___ in ulcerative colitis, it ____ crohn’s

A

protective

worsens

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20
Q

gene mutation related to crohn

A

CARD15/NOD2

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21
Q

populations in which IBD is present

A

bimodal age= 20s-40s and then 70s-90s
jewish + whites
high SES, hx of abx use in the first year of life

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22
Q

increase risk of what infectious agents with IBD

A

salmonella
shigella
campylobacter
C Dif

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23
Q

serum Ag levels of ___ are seen with ulcerative colitis, and of ___ in crohn

A

ANCA

ASCA

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24
Q

what does fecal lactoferrin indicate

A

intestinal inflammation (think IBD)

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25
what does fecal calprotectin indicate
predict relapses and detect pouchitis
26
diagnostic imaging for IBD
single contrast barium enema CT w contrast, CT/MR Enterography sigmoidoscopy, colonoscopy EGD
27
sx of crohn
``` RLQ pain fever diarrhea no blood growth retardation acute ileitis looks like appendicitis anorectal rissure ```
28
trx for crohn and ulcerative colitis
5-aminosalicylic acid derivatives corticosteroids, immunomodulating agents, biologic agents (for Crohn also add abx, IVF w NGT suction)
29
sx of ulcerative colitis
6+ bloody BMs/day, tenesmus/fecal urgency, systemic vasculitis,
30
sx and dx of toxic megacolon
super sick shock, sicker than they have ever been dont want to increase the P or will perforate, so get a plain Xray and call surgery
31
extra-intestinal manifestations of IBD (7)
``` pyoderma gangrenosum (UC) oral aphthous ulcer (early sx in crohn) iritis anterior uveitis toxic megacolon (UC) erythema nodusum ankylosing spondylitis ```
32
hx of ischemic colitis
sudden onset of cramping LLQ pain, desire to defecate, passage of bloody diarrhea in older patients with atherosclerotic ds in younger patients with cocaine use
33
dx and trx of ischemic colitis
thumb printing on abd xray, sigmoidoscopy w submucosal hemorrhage, friability, and ulceration trx= NPO, IV fluids, surgical resection
34
hx of acute mesenteric ischemia
periumbilical pain out of proportion to tenderness writhing in pain but physican exam isn'y impressive "food fear", abd pain worsens after eating
35
dx and trx of ischemic colitis
dx= thumb printing on xray, submucosal edema CR angiography trx= restore intestinal blood flow past an obstruction via laparotomy, post op anticoag in mesenteric venous thrombosis
36
hx, dx, trx of hemorrhoids
hx= increased P in venous plexus with straining to poop or pregnancy, bright red blood drops on tissue, dx on anal inspection or anoscopy trx= bulk laxative and stool softeners, analgesics, rubber band ligation or injection sclerotherapy
37
complications of hemorrhoids
thrombosed external hemorrhoid acute, exquisite pain, tense, bluish perianal nodule
38
etiology of an anal fissure
linear or rocket shaped ulcers due to trauma to the anal canal during defecation
39
hx, dx, trx of anal fissure
hx= severe, tearing pain during defecation followed by throbbing discomfort maybe a little bit of blood dx= external anal inspection or anoscopy trx=fiber supplements, sitz baths, topical anesthetics, relaxation of anal canal w nitroglycerin ointment, internal anal sphincterotomy in refractory cases
40
anaorectal infections can lead to __, characterized by anorectal discomfort, tenesmus, constipation, and discharge
proctitis
41
most cases of proctitis are transmitted ___, especially ___
sexually | anal receptive
42
dx of N. gonorrhea anorectal infection
cultures from pharynx urethra (M) / cervix (F)
43
dx of treponema pallidum anorectal infection
dark field microscopy or flourescent Ab, VDRL or RPR test
44
dx of chlamydia trachomatis
serology, culture, PCR
45
hx with chlamydia anorectal infection
proctocolitis w fever, bloody diarrhea, perianal ulcerations, anorectal strictures, fistulas, inguinal adenopathy, MSM
46
dx of herpes simplex type 2 anorectal infection
viral culture, PCR, or Ag detection | viral shedding for several weeks after resolution
47
anal CA can be associated with chronic irritation from
``` condyloma acuminata perianal fissures/fistulas chronic hemorrhoids leukoplakia trauma from anal intercourse ```
48
etiology of anal ca
HPV virus
49
populations and hx associated with anal CA
women and MSM bleeding, pain, perianal mass
50
trx and complications of anal CA
trx= radiation therapy plus chemo complications= tumors may spread to the lung early on
51
etiology of pruritis ani
poor anal hygeine, or overzealous cleansing with soaps
52
hx, dx, trx of pruritis ani
hx= perianal itching and discomfort dx= external anal inspection or anoscopy trx=education, premoistened wipes, topical glucocorticoid, and anti-fungal agent if indicated
53
most polyps are what kind
mucosal adenomatous polyps
54
FAP sx and dx and trx
early development of 100s-1000s of polyps detect w gene detection of APC and/or MUTYH gene trx= complete proctocolectomy with ileoanal anastomosis prophylactic colectomy
55
etiology of lynch syndrome
lifetime risk of colorectal cA, endometrial CA, and other CAs developing at a young age polyps undergo rapid transformation over 1-2 years from normal tissure --> adenoma --> CA
56
dx, trx of lynch syndrome
dx= genetic counseling to look for x mismatch repair mechanism, immunohistochemical staining trx= subtotal colectomy w ileorectal anastomosis with annual surveillance of the rectal stump women undergo screening for endometrial/ovarian CA at 30 prophylactic hysterectomy
57
hx, dx, trx w nonfamilial adenomatous & serrated polyps
hx= mostly asx but all the bleeding can cause anemia dx= barium enema, CT colongraphy, COLONOSCOPY IS THE BEST = most sensitive trx= postpolypectomy surveillance
58
three syndromic presentations in which you will see hamartomous polyps
peutz-jeghers syndrome= HP throughout GI tract, may lead to gelatinous stools (s/p intussusception), mucocutaneous pigmented macules on the lips, buccal mucosa, and skin familial juvenile polyposis= more than juvenile HPs most commonly in colon, increase risk of adenocarcinoma PTEN multiple hamartoma syndrome (Cowden) - HPs and lipomas throughout the GI tract, and cerebellar lesions - increased rate of malignancy in thyroid, breast, and urogenital tract
59
what makes someone have an above avg risk for colorectal CA
- get a colonoscopy every 5 years starting at 40 or 10 yrs before the staring age of youngest relative w it if have - first degree relative, dx at<60 or two first degree relatives at any age - get colonoscopy every 5 years starting at 40 if - first degree relative w colorectal CA or adenoma dx at >60, or teo second degree relatives with colorectal CA
60
screening and tests for colorectal CA
FOBT, FIT, and fecal DNA tests
61
strep bovi bacteremia in ppl >45 is associated with
adenocarcinoma of the colon
62
left sided colon CA presents with vs right sided colon CA presenting with
left= rectal bleeding, altered bowel habits, abd/back pain right= anemia, occult blood, weight loss, other
63
hx and dx of AVM
= angiodysplasia -painless bleeding/occult blood loss, -common hx of chronic renal failure or aortic stenosis if proximal to Lig or Treitz, can present with melena dx= CBC, iron studies, endoscopic workup
64
TIPS procedure is for
long term decreased portal HTN
65
trx for stomach ulcer
IV pantoprazole (PPI)
66
normally, start transfusion therapy if Hgb is less than in CAD, start transfusion therapy if Hgb is less than
7 | 10
67
giving someone iron can cause what s.e.
constipation | darker colored urine

GI2 E1 (19 decks)

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