Bowel diseases

Question 1

Irritable bowel syndrome

Answer 1

Recurrent abd pain with more than 2 of the following:

• pain improves with defecation
• change in stool frequency
• change in apperance of stool

No structural abn
Most common in middle aged women
Chronic
Diarrhea, constipation and alternating symptoms
Multifaceted causes.

Question 2

Appendicitis

Answer 2

Adults: obstruction by fecalith
Kids: lymphoid hyperplasia

Diffuse umbilical pain migrating to McBurney’s point
DDx: diverticulitis (elderly), ectopic pregnancy (hCG to rule out)

Question 3

Diverticular disease:

Types

Answer 3

1) diverticulum
2) divertiolosis
3) diverticulitis

Question 4

Diverticular disease:

Diverticulum

Answer 4

Most often in sigmoid
Mucosal and submucosal outpouch only
Occurs esp where vasa recta performate muscularis externa.

Question 5

Diverticular disease:

Divertuculosis

Answer 5

Many false diverticula
Common in >60 ages
Caused by high intraluminal pressure and focal weakness
Associated with low fiber diet

Often asymptomatic or vague discomport
A common cause of hematochezia.
Complication: diverticulitis, fistulas

Question 6

Diverticular disease:

Diverticulitis

Answer 6

LLQ pain, fever, leukocytosis

Stool occult blood is common +/- hematochezia
MAy also cause colovesical fistula (with bladder), then pneumaturia

Sometimes called left-sided appendicitis due to overlapping clinical symptoms.

Question 7

Zenker’s diverticulum

Answer 7

False diverticulum
Herniation of mucosal site at Killian’s triangle between thyropharyngeal and cricopharyngeal parts of the inferior pharyngeal constrictor

Presenting: halitosis, dysphagia, obstruction.

Question 8

Meckel’s

Answer 8

Vitelline duct
Melena, RLQ pain, intussusception, volvulus or obstruction near the terminal ileum

contrasts with omphalomesenteric cyst = cystic dilation of vitelline duct.

Dx: pertechnetate study for ectopic reuptake.

Question 9

Five 2’s of Meckel’s

Answer 9

2 inches long
2 feet from ileocecal valve
2% of population
2 years of life
2 types of epithelia common

Question 10

Intussusception

Answer 10

Often at ileocecal junction
Currant jelly stool and compromise blood supply
Unusual in adults (suspect mass or tumor)
Majority in children (viral)
Abdominal emergency in early childhood

Question 11

Volvulus

Answer 11

Twisting around mesentery
Cecum and signmoid where redundant mesentery
Usually in elderly.

Question 12

Hirschsprung’s

Answer 12

Congenital megacolon by lack of ganglion cells/enteric nervous plexuses (Auerbach's and Meissner')
Failure of NC migration
Chronic constipation early in life
Involves rectum
Failure to pass meconium

Increased risk with Down syndrome.
Dx with rectal suction bx

“If you have Down, you got Down(butt) problem”