ABD Pain and Colon Dz Flashcards
What to think with RUQ pain
- liver (hepatitis)
- common bile duct (cholecystitis, cholangitis)
- lungs (PE, pneumonia)
- duodenum (ulcer)
What to think with RLQ pain
- bowels (appendicitis, perforated ulcer, IBD,
- inguinal hernia)
- male GU (testicular torsion)
- female GU (ectopic, PID, ovarian cyst)
- ureters (ureterolithiasis)
WHat to think with LUQ pain
- pancreas (pancreatitis)
- spleen (splenic dz)
- lungs (PE, pneumonia, subphrenic abscess)
What to think with LLQ pain
- bowels (diverticulitis, IBD, inguinal hernia)
- male GU (testicular torsion)
- female GU (ectopic, PID, ovarian cyst)
- ureters (ureterolithiasis)
presentation od proximal vs distal vs rectal vs metastatic colon cancer
Proximal colon: bleeding →
melena, iron-deficiency anemia,
fatigue, dull pain
Distal colon: obstruction →
constipation, colicky pain,
hematochezia
Rectal cancer: hematochezia,
rectal mass, tenesmus
Metastatic: portal drainage to
liver → jaundice, ↑LFTs
Imaging used to diagnose colon cancer
barium enema showing apple core + CEA marker
Duke staging of colon cancer + treatment
- Duke stage A (local) → Tx surgery
- Duke stage B (invasive) → Tx surgery
- Duke stage C (LN) → Tx surgery + chemo (5-FU, leucovorin) + Radiation if Rectal
- Duke stage D (mets) → Tx surgery + chemo
- (5-FU, leucovorin) + Radiation if Rectal
FAP: mutation, presnetation Tx?, prognosis?
AD ∆APC → thousands of
polyps → 100% progression to
CRC; Tx ppx colectomy
gardner vs turcot syndrome
Gardner syndrome: FAP +
osteomas, soft tissue tumors
Turcot syndrome: FAP + CNS
tumors
multiple nonmalignant
hamartomas throughout GI tract
w/ pigmented spots around
mucus surfaces
Peutz-Jeghers syndrome
HNPCC/Lynch: mutation, presnetation, prognosis
AD ∆DNA repair genes → hundreds of polyps → 80% progression to
CRC
MC type of polyms + management
hyperplastic, no malignant potential so leave alone
type of polyps found in kids + management
juveline, remove due to vascularity
polyps with high risk of malignant potential
adenomatous polyps
presentation of diverticulitis vs diverticulosis
litits = elevated WBC, no bleeding, Dx with CT scan, need IV abx
osis = painless rectal bleeding, Dx with barium enema, need stool softeners
complications of diverticulitis vs osis
itis = abcess, bowel obst, colovesicualr fistuals, perforation
osis - hypovolemic shock, diverticulitis
MCC LGI bleed
Angiodysplasia (vascular
ectasia, AVM)
Heyde syndrome: angiodysplasia
+ aortic stenosis
Heyde syndrome
Tx for angiodysplasia
observation (90% stop spontaneously), colonoscopy w/ coagulation (2nd line)
etiologies of acute mesenteric ishemia and how to distingiuish between them
Arterial embolism: MCC, most
sudden and severe
Arterial thrombosis: gradual
onset and less severe
Nonocclusive ischemia: due to
↓CO, seen in critically ill pts
Venous thrombosis: rare,
slowest onset and least severe
postprandial dull abd pain, think?
Dx? Tx?
Chronic mesenteric ischemia (artherlosclerosis of celiac artery, SMA or IMA)
- Dx mesenteric angiography
- Tx surgical revascularization
colonic pseudoobstruction w/o
mechanical cause → bloating,
obstipation, nausea/vomiting
Dx? Tx? etiology
Ogilvie syndrome
- Dx of exclusion (r/o other causes)
- Tx underlying cause, decompressive colonoscopy (2nd line), neostigmine (3rd line)
- colon >10 cm → Tx emergent decompression
Etiology surgery, trauma, drugs (opiates)
how to dx and tx pseudomembranous colitis
C diff toxins
flagyl > po vanc
complications of pseudomembranous colitis
toxic megacolon and perforation
acute-onset colicky pain,
obstipation, nausea/vomiting
Dx KUB shows Omega loop sign (dilated sigmoid colon) or coffee bean sign (cecum
volvulus
Tx for volvulus
- sigmoid volvulus → Tx sigmoidoscopy w/ decompression ± elective surgery
- cecal volvulus → Tx emergent surgery
**MC site is sigmoid
What imaging is used to Dx appendicitis
CT
What are the diff physical exam tests/signs for appendicitis
Rovsing sign: LLQ pressure
causes referred RLQ pain
Psoas sign: right psoas flexion
causes RLQ pain
Obturator sign: right obturator
flexion causes RLQ pain
McBurney point: 2/3 distance
from umbilicus to right ASIS
MC tumor of appendix
How to Dx? Tx?
Carcinoid (makes 5-HT)
get CT scan
Tx appendectomy (2 cm)
What is carcinoid syndrome? How is ti diagnosed?
metastasis of carcinoid tumor to liver → systemic 5-HT effects → flush + diarrhea + wheezing + TIPS (tricuspid insufficiency, pulmonary stenosis)
Dx with urinary 5-HIAA
colicky abd pain, n/v,
obstipation or constipation with KUB showing dilated loops and air fluid levels
Tx? Etiologies? Complications?
SBO
Tx NPO/IVF/NG tube, observation
Etiology: adhesions from prior abd surgery (MCC), hernias (#2)
Complications: septic shock,
gangrene, peritonitis, bowel
perforation
Meds that cause paralytic ileus
narcotics, anti-cholinergics
electrolyte imbalance that can cause paralytic ileus
hypoK
how to Dx celiac sprue?
Dx anti-gliadin or anti-endomysial ab
presentations of chrons vs US
Chrons: flare-and-remission pattern of crampy abd pain, bloody diarrhea, recent weight loss -MOUTH to ANUS/skip
UC: flare-and-remission pattern of crampy abd pain, bloody
diarrhea, recent weight loss -COLORECTAL ONLY/continuous–ALWAYS INVOVLES RECTUMMM
KUB and tissue bx chrons vs UC
Chrons: KUB with terminal ileum string sign tissue bx with transmural, noncaseating granulomas, creeping fat, SKIP LESIONS
UC: KUB with lead pipe sign and tissue bx with mucosal invovlement only, cryp abcesses, pseudopolyps, CONTINUOUS LESIONS
Tx for chrons vs UC
Chrons:
• Tx steroids + 5-ASA (sulfsalazine)
• perianal Crohn → Tx metronidazole
• rectal Crohn → Tx subtotal colectomy
UC:
• Tx steroids + 5-ASA (sulfsalazine)
• severe dysplasia → Tx total proctocolectomy
Complications seen with chrons vs UC
Chrons: erythema
nodosum, SBO, fissures/fistulae
UC: CRC, pyoderma
gangrenosum, sclerosing
cholangitis, cholangiocarcinoma,pouchitis, toxic megacolon
What is pouchitis and how is it treated?
Pouchitis: fever, bloody diarrhea, and dyscgezia s/p ileal puch formation in UC pt
tx with metronidazole
