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15feb 24 Flashcards

1
Q

RF for Colon CA
Lifestyle factors

A

Freq consumption of red/processed meat
Tobacco
Alcohol

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2
Q

RF for colon CA
Medical/family hx

A

👧🏼Personal/FH of adenomatous polyps or colon CA
👧🏼Inherited colon CA syndromes
(FAP , Lynch syndrome)
👧🏼UC
👧🏼Diabetes/ Obesity
👧🏼Prior abdominopelvic radiation

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3
Q

Protective factors for COLON CA

A

High fibre diet
Aspirin / NSAID

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4
Q

How does obesity and type 2 Diabetes cause CRC

A

Cause early onset CRC age <50
Hyperinsulinemia causes Inc in IGF-1
Which inhibits colorectal epithelial cell apoptosis and promotes neoplastic progression.

Obesity also causes increased exp of Inflammatory Cytokines TNF-alpha
Which promotes dev of CRC.

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5
Q

Why would aspirin and NSAIDS cause protective effect on CRC

A

Inhibit COX2 an enzyme involved in carcinogenesis
(But not usually given due to risk of GI bleed and renal failure)

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6
Q

Colovesicular fistula etiology

A

👅Diverticular dx (sigmoid most common)
Ruptured diverticulum or diverticular abscess extends into bladder
👅Crohn dx
👅Malignancy (colon, bladder, pelvic organs)

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7
Q

CF of colovesicular fistula

A

Pneumaturia (air in urine)
Occurs at the end of urination due to gas collection at the top of bladder

Fecaluria. (Stool in urine)
Recurrent UTIs. (Mixed flora)

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8
Q

Dx of colovesicular fistula

A

👤CT scan abdomen with oral or rectal contrast (not IV)

👤Colonoscopy to exclude colon malignancy.

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9
Q

Ttt of CV fistula

A

Surgery

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10
Q

Acute diverticulitis CF

A

🗣LLQ Abd pain(most cases arise in Sigmoid colon the site for greatest intraluminal pressure)
🗣NV
🗣altered bowel movements (loose stools in patient with constipation)
🗣Fever
🗣Leukocytosis
🗣Possible sterile pyuria
🗣Dysuria / urgency or freq due to bladder irritation from adj inflammed sigmoid colon.
🗣palpable tender mass from focal inflammation.

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11
Q

DX of acute diverticulitis

A

CT scan abdomen(oral or IV contrast)
Shows Focal bowel wall thickening and inf signs (stranding) in pericolonic fat.
May also show abscess or phelgmon(inf tissue mass)

Colonoscopy is done 6-8w later to rule out CA (which can be a RF to Acute diverticulitis)
Inc risk of perforation if done in acute phase.

Signoidoscopy with barium enema done in pts who cant undergo colonoscopy.

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12
Q

Ttt of acute diverticulitis

A

Bowel Rest
AB (cipro , metronidazole)
Colonoscopy 6-8w after resolution

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13
Q

Complications of acute diverticulitis

A

Abscess
Obstruction
Fistula
Perforation

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14
Q

Toxic megacolon pathophys

A

🧠Colonic Smooth Muscle Inf and paralysis
🧠Complication of IBD or infectious colitis
🧠Inc Risk with use of antimotility agents
(Loperamide) or opiods.

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15
Q

CF of TM

A

💄Fever tachycardia hypotension
💄Abd pain and distension following diarrheal illness

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16
Q

Dx of TM

A

CT scan with IV and oral contrast
With features ;

🫁Colon dilation >6cm (diagnostic)
🫁Loss of normal haustral pattern
🫁Irregular mucosal pattern with areas of ulceration alternating with areas of edema

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17
Q

Ttt of TM

A

🦷Bowel Rest / decompression
🦷AB
🦷iv Corticosteroids if IBD associated
🦷Surgery for perforation peritonitis clinical deterioration

Sulfasalazine is not given in TM

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18
Q

RF of acute diverticulitis

A

Complication of diverticulosis
Which is
Herniation of colon mucosa and submucosa through circular and longitudinal muscle layer due to elevated intraluminal pressure.

👃🏽RF
Increased age
Obesity
Poor diet (low fibre , high red meat)
Tobacco

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19
Q

Modified Alvarado score

A

1 point for
Migratory RLQ pain
Anorexia
N or V
Fever > 99.5
RLQ rebound tenderness

2 points for
RLQ tenderness
Leukocytosis >10,000 /mm3

9 total possible Score

0-3 : Appendicitis unlikely
>-4 : evaluate for appendicitis

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20
Q

Management of appendicitis

A

Modified alvarado score >-4
⬇️
Pt is child or pregnant FM do USG or MRI

Otherwise do CTscan
⬇️
🔼Normal appendix. Check for other causes

🔼Non visualized appendix Management depends on specific alvarado score

🔼Non perforated appendicitis
AB plus surgery <-12hrs

🔼Perforated appendix
AB plus bowel rest
Do PCD for contained abscess
I &D with appendectomy for diffuse contamination

21
Q

Perianal abscess CF and RF

A

Fluctuant mass/ swelling with erythema
Severe constant pain
Fever
Gradual onset
Pruritis
Pain with defecation

RF : constipation
Anoreceptive intercorse

22
Q

Cause of perianal abscess

A

Due to Occlusion of Anal Crypt Gland which allows bacterial overgrowth
Abscess forms quickly due to high levels of bacteria in the area.

23
Q

Ttt and complications

A

Anorectal fistula
Intersphinteric abscess
Anal sepsis

Ttt : I & D

24
Q

Thrombosed external hemorrhoid cause

A

Hemorrhoids are abnormal dilations of hemorrhoidal venous plexus and categorized in relation to dentate line as internal (proximal) or external (distal)

Thrombosis occurs in external hemorrhoid and manifests as excruciating anorectal pain exacerbated by sitting.

Dx. Anoscopy

25
RF for hemorrhoids
⏹Constipation ⏹Abnormal defecation (straining , prolonged sitting on toilet) ⏹Increasing age ⏹Pregnancy.
26
Ttt of hemorroids
Sitz bath Stool softeners Topical anesthetics Refractory: surgery
27
Hemorrhoids vs abcess
Thrombosed hemorrhoids have more acute presentation While perianal abscess has fever with swelling and induration on overlying skin. Or purulent fecal drainage. Abscess is related to corhns
28
Classification of internal hemorrhoids
Grade 1: No proplapse , only prominent vasculature Grade 2: Prolapsed tissue only with straining and reduces spontaneously Grade 3: Prolapsed beyond dentate line that can be reduced manually Grade 4 : Prolapsed tissue not reduced manually
29
Duodenal hematoma mechanism
Children have less protective abdominal walls (thin musculature and less adipose ) and are therefore more prone Compression of duodenum against vertebral column during BAT Blood vessels between submucosa and muscularis layers cause bleeding and hematoma formation As hematoma progressively expands over 24-48hrs partial or complete obstruction of duodenal lumen develops. Patients have delayed presentation.
30
SS of duodenal hematoma
Epigastric pain Bilious emesis Xray : gastric dilation with scant distal gas
31
DH dx and ttt
Dx : CT is diagnostic Ttt: NG decompression Bowel rest Parenteral nutrition Majority resolve with non operative ttt PCD or surgery for DHs that persist beyond few weeks
32
Aspects of duodenal anatomy that increase risk for perforation
Location anterior to vertrbral coulmn Multiple attachments (Ligamnet of treitz , hepatoduodenal lig) Leading to tearing at fixed points rather than stretching.
33
SS of duodenal perforation
Fever Diffuse abd pain Flank pain(retroperitoneal inflammation) Retroperitoneal free air on XRay Ttt: surgery
34
Retroperitoneal organs
SAD PUCKER
35
Cause of anorectal fistula
Perianal abscess Crohn dx Malignancy , radiation proctitis Infection (lymphgranuloma venereum)
36
CF of anorectal fistula
Perianal pain , discharge Inflmmatory papule /pustule Palpable fistula tract
37
Ttt of anorectal fistula
🚾Assess extent of fistula Gentle probe Imaging (endosonography, fistulogram, MRI ) 🏧Surgery (fistulotomy) The entirety of fistula must be addrrssed as residual fistula tracts lead to persistent symptoms and fecal incontinence.
38
Cause of anorectal fistula
Most often due to rupture of perianal abscess with formation of residual sinus tract.
39
GI perforation after BAT
Acute Or Delayed Delayed perforation cause: 🅿️Bowel contusion: progresses to full thickness injury 🅿️Injured mesenteric hematoma : Progresses to ischemia and necrosis Ttt : observation due to risk of progression to perforation (presenting as intraperitoneal free air-perforated viscus) Immediate surgery if signs progress to perforation (abd tenderness with guarding)
40
Common cause of SBO in adult
Abd surgery causing adhesions.
41
Simple SBO vs Strangulated SBO
Simple : luminal occlusion Stragulated : peritoneal signs and signs of shock Fever tachycardia , leukocytosis (late)
42
Severe CDI clinical indicators that warrant surgery
🚹Signs of peritonitis 🚹Megacolon : >6cm diameter on Xray with associated loss of sm muscular tone (decreased diarrhea) 🚹Increased serum Lactate : Marker of colon ischemia.
43
Acute diverticulitis entire management
Acute LLabd pain and tenderness CT scan : focal bowel wall thickening +_ visible diverticuLa 🤬No high risk features / complications Age <70 no fever no leukocytosis Outpt management Oral fluids Oral AB Close follow up 🤬High risk features: Age >70 Comorbidities Immunosuppression Sepsis / SIRS ⬇️ Inpatient management Bowel rest IV fluids IV AB 🤬COMPLICATIONS 🏧Abscess. IV antibiotics with percutaneous drainage 🏧Perforation, obstruction, fistula IV antibiotics Surgery
44
How to manage diverticular abscess
Small abscess <4cm. IV antibiotics No drainage required Large abscess >-4cm Drainage Percutaneous drainage is done under CT or USG leads to clinical improvement in 48hrs.
45
Acute colonic psudoobstruction (ogilvie syndrome) etiology
Major surgery , traumatic injury , severe infection Electrolyte derangement (dec K , Mg, Ca) Medications (opiates , anticholinergics) Neurologic disorders (dementia , stroke)
46
Acute colonic pseudoobstruction CF
🧠Abdominal distension , pain , obstipation, Vomiting 🧠Tympanic to percussion 🧠Dec bowels 🧠If perforation : guarding , rigidity , reboundtendernezs
47
Acute colonic psudoobs imaging
Xray : Colonic dilation Normal haustra Nondilated small bowel CT scan : Colonic dilation without anatomic obstruction
48
Ttt of acute colonic psudoobstruction
🦷NPO , NG /rectal tube decompression 🦷Neostigmine if no improvement within 48hrs

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