Adult - GI II Flashcards
inflammation or localized perforation of diverticula with abcess formation
diverticulitis
diverticulitis - more common in men or women
women
Typical location of pain of diverticulitis?
LLQ
Signs and symptoms of diverticulitis? (3)
LLQ pain
low grade fever
nausea, vomiting
constipation or loose stools
What is a potentially significant complication of diverticulitis?
bowel perforation –> peritonitis –> acute abdomen
What test rules out perforation of the bowel?
plain abdominal films
+ for perforation if free air under diapragm
What might lab work show in diverticulitis?
leukocytosis
elevated ESR
Management of diverticulitis (2)
patient may be NPO
may refer to GI
What is the cause of irritable bowel syndrome?
etiology is unknown but there is a stress theory
Irritable bowel syndrome - more common in men or women
women
What are the signs and symptoms of irritable bowel syndrome? (4)
abdominal cramping relieved by defecation
preoccupation with symptoms
fatigue
anxiety or depression
Management of irritable bowel syndrome (3)
emotional support
high fiber diet
SSRIs
What can be used in severe cases of irritable bowel syndrome? (2)
anticholinergics
antidiarrheals
what often precipitates cholecystitis?
a large or fatty meal
What is the typical pain of cholecystitis?
steady, severe pain in RUQ
What is classic SIGN for cholecystitis?
Murphy’s sign - pain on INspiration when fingers placed under the R rib cage
What is the gold standard for cholecystitis evaluation?
ultrasound
What is the management for cholecystitis? (6)
Refer for: pain management NG tube for gastric decompression IV crystalloids broad spectrum ABT GI and surgical consult
Possible causes of bowel obstruction (6)
tumor hernia fecal impaction adhesions volvulus - in children - twisting/malrotation of bowel ileus (functional obstruction)
Vomiting with minutes of pain indicates what about the location of the obstruction?
proximal location
More marked distention indicates what about the location of the obstruction?
distal location
Bowel sounds of obstruction?
high-pitched tinkling…going around the obstruction
Bowel sounds of perforation?
quiet….ominous
Patient with obstruction will tell you what about their stool or gas?
“unable to even pass gas”
What will plain abdominal films show in obstruction?
dilated loops of bowel
and
air-fluid levels
What does management include in obstruction? (5)
Refer for: NG tube broad spectrum ABT fluid resuscitation GI - surgical consult
What is hallmark symptom of ulcerative colitis?
bloody diarrhea
What test establishes the diagnosis of ulcerative colitis?
sigmoidoscopy
What factors are associated with increased risk of colon cancer?
family history of colon cancer or other adenocarcinomas inflammatory bowel disease polyps high fat diet refined carb diet
What are common early symptoms of colon cancer?
None - often asymptomatic in early stage
What are late symptoms of colon cancer?
changes in bowel habits
thin stools
weight loss
What is the marker for colon cancer?
CEA - carcinoembryonic antigen
nonsmokers < 2.5 ng/mL
smoker < 5 ng/mL
Who presents most commonly with appendicitis?
men 18 - 30 years old
What are possible triggers for appendicitis?
fecalith - food bits like diverticulitis
neoplasm (rarely)
Early pain of appendicitis?
vague, colicky umbilical pain
Late pain of appendicitis?
RLQ
Psoas sign
pain with R thigh extension
+ appendicitis
Obturator sign
pain with R thigh internal rotation
+ appendicitis
Rovsing’s sign
RLQ pain when LLQ is pressed
+ appendicitis
Is frequent vomiting associated with appendicitis?
no - more than one or two episodes suggests a different diagnosis
What imaging studies are diagnostic of appendicitis?
CT or ultrasound
