GI Packet 5

What is hematochezia?

Bright red blood in stool (sign of lower GI bleed)

What is the term for bright red blood in stool?

Hematochezia

What is Melena?

Black-tarry stool (upper GI bleed)

What is the term for black-tarry stool?

Melena

What is an occult GI bleed?

Hidden/unseen blood in GI

What is the term for hidden/unseen blood in GI?

Occult GI bleed

What is Hematemesis?

Vomiting blood

What is the term for vomiting blood?

Hematemesis

What is the definition for gastrointestinal (GI) bleeding?

Bleeding from any site from the mouth to the anus

How do you recognize GI bleeding is internal?

Sometimes you don’t

Important to pay attention to symptoms

What are the symptoms of a UGI bleed?

Vomiting bright red blood, passing black, tarry stools (melena - can look like dark coffee grounds)

What are the symptoms of a LGI bleed?

Passing pure blood or blood mixed with stool

What is the ligament of Treitz?

Musculofibrous band that attaches to the duodenum and diaphragm

What type of bleeding would you expect from GI bleeding in the esophagus?

Vomiting bright red blood or coffee ground material in/black stools

What are some reasons for esophageal bleeding?

Ulcers, varices

What type of bleeding would you expect for stomach bleeding?

(Hematemesis) Vomiting bright red blood or (melena) coffee ground material in/black stools

What are some possible reasons for gastric bleeding?

Ulcer, gastritis

What type of bleeding would you expect with small intestinal bleeding?

Bright red/maroon rectal bleeding

What are some possible reasons for small intestinal bleeding?

Ulcer, tumor

What type of bleeding would you expect with large intestinal bleeding?

Blood in stool

What are some possible reasons for large intestinal bleeding?

Colon tumor, polyps, inflammatory bowel disease (IBD)

What type of bleeding would you expect in rectal bleeding?

Bright red bleeding

What are some causes for rectal bleeding?

Hemorrhoids, tumor

What are some risk factors for GI bleeding?

NSAID use, age, previous ulcer, excessive alcohol, blood thinners (anticoagulant)

What 2 risks together increase your risk of GI bleeding by 12?

NSAIDs use and being on blood thinners (anticoagulants)

What do we base our treatment of GI bleeding on

The cause

Who do we screen for GI bleeding?

People at higher risk categories and those that are 45 and older

What is done to diagnose GI bleeding?

Rectal exam (may appreciate hemorrhoids)

(FOBT) Fecal occult blood test (FOBT - measures the heme portion of blood to see if there is blood)

(FIT) Fecal immunochemical test (Checks for the globin portion of blood)

Cologuard (DNA test for early cancer based on stool)

Shield test (DNA test based on blood - Good at detecting late-stage cancer but not early stages)

Endoscopy

Sigmoidoscopy

Colonosocpy

What is the definition of diarrhea?

Abnormally frequent and liquid stools

What types of diarrhea are there?

Acute and chronic?

What is acute diarrhea?

A few days

What is chronic diarrhea?

Greater than a month

What are some causes for diarrhea?

Viruses (Norwalk virus - #1 cause in U.S., rotavirus - #1 cause in world)

Parasites (Giardia - #1 parasite)

Contaminated food/water

Bacteria (E. coli (#1 cause in travelers), Cholera, C. diff., Cyclospora, Salmonella, Shigella)

Lactose intolerant

Foods (artificial sweeteners - saccharin, sucralose, aspartame)

Medications (antibiotics, weight-loss medication (Zenacell - can’t find online))

Disease processes (IBS, IBD, celiac disease)

Stress

What pertinent questions should you ask when trying to find the reason for diarrhea?

Detailed history

7 factors

New medication

Change of routine

Have you recently traveled

What pertinent exams can you do to find the reason for diarrhea?

Abdominal exam

Rectal exam

Check on skin (tenting for dehydration)

Stool culture

What is the treatment for diarrhea?

Most heal on own

If dehydrated, get them liquids (electrolytes like those in Gatorade is important)

Treat underlying cause

Imodium only for short-term

What is the definition of constipation?

Symptoms of infrequent bowl movements, passing of hard stools, or straining while moving a bowel

What are the symptoms of constipation?

Passage of hard stool few than 3 times a week

Strain frequently during bowel movement

Abdominal bloating or discomfort

What is constipation secondary to?

Slow transport through colon

What are some contributing factors to having constipation?

Decreased fluids

Low-fiber diet (30-40 grams needed)

Lack of physical activity

Pregnancy

Certain medications (opiates, narcotics)

Parkinson treatment

Depression treatment

What testing can be done to diagnosis the cause of constipation?

Sigmoidoscopy

Colonoscopy

What is the treatment for benign constipation?

Increased fiber

Exercise

Water

Stool softeners (adds bulk to stool)

Tell kids to go when they need to (kids often don’t listen to bowel movement)

What is the definition of colon cancer?

Cancers that arise in the colon (cecum to anus)

How does colon cancer develop?

Slowly (slow growing where they stary as polyps and progress)

What are the symptoms of colon cancer?

Asymptomatic

But can have…

Pain (mostly not till later stages but may have some with bowel movement)

Fatigue

Bleeding

Weight loss

Change and/or bleeding with bowel movement

Constipation

What are some risk factors for colon cancer?

Age (90% over age 50 and we’re starting to find it in younger people)

Personal or family history of colon cancer or polyps

Diet (low fiber)

Sedentary lifestyle

Diabetes

Obesity

Smoking and alcohol (possible causes)

Longstanding IBD

What are some tests we can do to diagnose colon cancer?

(FOBT) Fecal Occult Blood Test

Shield

Cologuard

Sigmoidoscopy/colonoscopy

Barium enema

Where can polyps be found in the body?

Anywhere

What do we base treatment for colon cancer on?

Staging of the cancer (TNM - tumor, nodes, metasises)

What kinds of polyps are there in the colon?

Ones of varying size and type (though she didn’t tell us anything more on types)

Small = 1% of cancer

Medium = 10% of cancer

Bigger the worse chance of cancer

What is the treatment for colon cancer?

Surgical treatment (excision of the cancer)

Chemotherapy

Radiation

Does it matter what order chemo and surgical treatment of colon cancer is in?

It can be in any order (S then C or C then S)

If surgeons have to excise a huge piece of colon what may they need?

Colostomy (Part of colon attached to abdomen and feces is taken out into a bag)

When we excise a cancerous polyp what do we do the surgeons do?

Polyp is removed, nearby tissue is removed (if cancer has spread), each separate piece of colon is connected, and a colostomy may be added depending on amount of colon that is excised

What are important steps to prevent colon cancer?

Screenings at 45 and younger for those at higher risk (10 years before a family member has had it) (screening every 10 years and 5 years for those at higher risk)

High-fiber diet

Eating vegetables and whole grains

Limiting fats and alcohol

Stopping smoking

Being active (physical exercise)

What are the stages of colon cancer?

Stage 0 - In inner layer of colon

Stage 1 - Through mucosa but hasn’t spread beyond colon wall

Stage 2 - Through colon wall but has not spread to lymph nodes

Stage 3 - Through and to lymph nodes, but no other body part

Stage 4 - Distant parts of body (likes liver, lung, and bones - spread and location differ)

#1 parasite to cause diarrhea

Giardia

#1 cause for diarrhea in the U.S.

Norwalk virus

#1 cause for diarrhea worldwide

Rotavirus

#1 cause for diarrhea for travelers

E. coli

What medications can cause diarrhea?

Antibiotics

Weight-loss medication (Zenacell - can’t find this drug online)