Week 10 Clinical Tx And Technique GI Bleed

Question 1

Risk of diverticulosis

Answer 1

Obesity and over 70yo

Spontaneous resolve in 75% times

Question 2

Diverticulosis bleed SX

Answer 2

1. Bright red blood
2. Painless*** (usually no abd tenderness)
3. 50% have had previous episode
4. Bloating or urge to defecate

Question 3

Risks for diverticulosis

Answer 3

1. Obesity
2. Red meats
3. Low fiber
4. Low exercise
5. Age
6. MEDS : NSAIDs, steroids, opiates,

Question 4

Diverticular bleeding Imaging

Answer 4

1. AAS (if free air concern)
2. Colonoscopy (hard to see) or endoscopic therapy to stop it
3. CT Pelvis/abd

Question 5

Diverticulosis TX

Answer 5

1. Colonoscopy / endoscopy
2. Angiography :if colonoscopy does not work)
3. Surgery if other 2 dont work (take colon out)

Question 6

Colonic ischemia (Ischemic colitis)
Prevalence of what happens, mortality, sx

Answer 6

1. 15% of pt with this get gangrene colon——> high mortality

2. LUQ/LLQ pain, hematochezia

Question 7

Risk for ischemic colitis

Answer 7

1. HTN
2. DM
3. Hyperlipidemia, hypercoagability
4. Smoking
5. Aorta-iliac surgery, shock, Female, vasoconstrictors

Question 8

ischemic colitis SX acute

Answer 8

Complete occlusion

• mild cramping, tenderness rapid onset, LEFT SIDE
• bloody stools
• pt is not severely ill

Question 9

ischemic colitis SX chronic

Answer 9

Non-occlusive

• recurrent ABD pain
• bloody D
• WL
• bacteremia
• sepsis
• colonic strictures

Question 10

Sx In necrosing colon

Answer 10

Peritoneal inflammation

Question 11

ischemic colitis labs

Answer 11

D -Dimer** = +
Low bicarb = ischemia
Lactic acid = already infarted bowel

Question 12

ischemic colitis imaging

Answer 12

Colonoscopy or sigmoidoscopy
CT + IV
ABD X-ray

Question 13

TX ischemic colitis

Answer 13

Support fluids
Anti-coags unless bleeding
Broad spectrum ABs
Bypass, vasodilation infusion , stunting, embolectomy , thrombolysis

Question 14

Colon cancer prevalence

Answer 14

Most
8% cancer deaths in US
= most common cause of slow LGIB blood loss (no evidence) maybe just anemic

Question 15

IBD type risk for colon cancer

Answer 15

UC

Question 16

Colon cancer risks

Answer 16

Obesity, male, smoking, processed meat, age, alcohol, low physical activity

Question 17

Colon cancer protection

Answer 17

NSAIDs

Question 18

Imaging colon cancer

Answer 18

Colonoscopy

Question 19

TX colon cancer bleed

Answer 19

1. Support and stability
2. Colonoscopy
3. Surgery Resection