what is hematochezia?
passage of fresh blood per rectum
What are some DDX for hemotochezia
- hamorrhoids
- Anal fissure
- DIverticular bleed
- IBD
- Infectious colitis
- Ischemic colitis
- AV malformation
- Polyps
what are the signs of hypovolemia?
- Mild to moderate hypovolemia: resting tachycardia
- blood loss of at least 15% = orthostatic hypotension (dec in systolic BP of more than 20mmHg and/or increase in HR of 20
- Blood loss of 40% = supine hypotension
How is smoking related to UC?
stopping is a risk factor for developing UC
What is the BUN:Cr ratio in an upper GI bleed?
30:1
What is the AST:ALT ratio in an alcoholic?
2:1
What is the anatomical division of upper Gi bleed vs lower GI bleed
ligament of Treitz
what are some diagnostic options for a pt with lower GI bleed
- radionuclide imaging (noninvasive and sensitive to low rates of bleeding, performed during active bleeding, poor localization of bleeding site)
- CT angiograph (noninvasive, performed during active bleed)
- Angiography (accurate localization, therapy possible, performed during active bleed, risk of serious complication)
- Colonoscopy ( precise diagnosis, requires time due to bowel prep)
what diagnostics are considered when there is a upper GI bleed?
High suspicion –> upper endoscopy (EGD)
Moderate suspicion –> NG tube with lavage (positive UGIB = coffee ground material or bright red blood; negative = billous
what is the initial management of an acute lower GI bleed
supportive: IV access, appropriate setting, O2, IVF, blood products, assessment and management of coagulopathies
In pts with ongoing bleeding or high risk clinical features: colonoscopy within24 hrs
What are potential complications/risks in pts with IBD?
UC: toxic megacolon, primary sclerosing cholangitis, ankylosing spondylitis, pyoderma gangrenosum
CD: Fistulas/strictures, fissures, pigmented gallstone formation, malabsorption
Both: Colon cancer, DVT
How fast can KCl be given through a peripheral IV?
10mEq/hr
How many g/dL would you expect the Hg to rise from 1 units packed RBC?
Giving 1 unit of PRBCs should increase Hgb by 1g/dL
during an acute IBD flare, what is the primary treatment
corticosteroids (IV or PO)
who should be tested/screened for colorectal cancer/
Those with symptoms of colorectal cancer (CRC) –> perform diagnostic studies
Those with no symptoms but at average risk and over 50 should have colonscopy q10yrs, or CTC q5yrs; or FIT annually
Those with increased risk and family hx: genetic testing and early intense screening. Family hx of FDR <60 with CRC or adenoma–>colonscopy starting age 40
what are some stool based tests for CRC screening?
- gFOBT yearly
- FIT yearly
- FIT-DNA q1-2yrs
what is the gold standard direct visualization test for CRC screening
colonscopy
