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Surgery > Chapter 12, part 3 > Flashcards

Chapter 12, part 3 Flashcards

1
Q

Pseudomembranous colitis

A

Overgrowth of C. diff (happens after abx use)

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2
Q

Transmission of pseudomembranous colitis

A

Fecal oral route

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3
Q

What are the two endotoxins that C. diff produces?

A

Enterotoxin
Cytotoxin
Cause mucosal damage resulting in exudative pseudomembrane on scope

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4
Q

Dx of pseudomembranous colitis

A

ELISA (and PCR if necessary)

GDH

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5
Q

Tx of pseudomembranous colitis

A

Initial: oral metronidazole or oral vanc (chosen in more severe cases)
In the case of septic shock, subtotal colectomy with end ileostomy

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6
Q

Causes of bloody diarrhea

A 
Shigella
C. jejuni
Enterohemorrhagic E. coli (EHEC)
E. histolytica
Certain salmonella
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7
Q

E. histolytica and bloody diarrhea

A

Causes amebic colitis

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8
Q

Amoebic colitis sx

A

Mimics IBD (crampy abd pain and bloody diarrhea)

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9
Q

Dx of amoebic colitis

A

Stool studies
Antigen testing
Endoscopy (ulcerations and trophozites)

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10
Q

Tx of amoebic colitis

A

Metronidazole + luminal agent (paromomycin)

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11
Q

Shigella and bloody diarrhea

A

Fecal-oral route or through contaminate food and water

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12
Q

Dx of shigella

A

Stool culture

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13
Q

Tx of shigella

A

Self-limiting, but can give FQ to reduce duration

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14
Q

EHEC

A

Fecal contamination of foods

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15
Q

MC sx of EHEC diarrhea

A

Hemorrhagic colitis

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16
Q

Tx of EHEC

A

Supportive

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17
Q

What is a major potential sequela of EHEC infection?

A

HUS (hemolytic uremic syndrome)
5-10 days after diarrhea
Acute renal failure, thrombocytopenia, and microangiopathic hemolytic anemia

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18
Q

Salmonella

A

Gastroenteritis caused by nontyphoidal strains= MC

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19
Q

Sx of salmonella bloody diarrhea

A

Abdominal pain
Fever
Vomiting 1-3 days after exposure

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20
Q

Tx of salmonella bloody diarrhea

A

Self-limiting, supportive

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21
Q

C. jejuni

A

Same sx and tx as salmonella

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22
Q

Cytomegaloviral colitis

A

Presents similar to appendicitis (tx with ganciclovir)

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23
Q

Neutropathic enterocolitis

A

MC affects cecum
Immunosuppressed pts undergoing chemo
Presents like appendicitis
Tx: bowel rest and IV abx

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24
Q

What is the MC site of bowel ischemia and why?

A

Colon

Usually d/t prolonged hypoperfusion secondary to hemodynamic instability

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25
Q

What is the MC site of the colon for ischemia

A

Watershed areas (splenic flexure)

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26
Q

S/sx of ischemia of the colon

A

Worsening abdominal pain (out of proportion to the exam)
Bloody diarrhea
Abdominal distention

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27
Q

Lab findings for ischemia of the colon

A

Lactic acidosis

Leukocytosis

28
Q

Rads for ischemia of the colon

A

CT:
Bowel wall edema or pneumatosis of intestinal wall
Sigmoidoscopy or colonoscopy:
Patchy hemorrhagic areas with dusky mucosa

29
Q

Tx of ischemia of the colon

A

If full thickness necrosis or perforation: urgent segmental resection and creation of stroma
Partial thickeness: abx, bowel rest, and correction of hypoperfused state

30
Q

Where can Crohn’s be found?

A

Anywhere in GI tract (mouth to anus)

Terminal ileum is MC

31
Q

What type of involvement occurs in Crohn’s?

A

Patchy involvement

32
Q

What components does Crohn’s affect?

A

Transmural inflammation

33
Q

Gross appearance of Crohn’s

A

Segments look grossly inflammed with thickened mesentery and creeping serosal fat

34
Q

What is seen on colonoscopy in Crohn’s?

A

Long longitudinal ulcers and erosions of the submucosa: cobblestoning

35
Q

Path of Crohn’s

A

Transmural infiltration with deep penetrating fissures through muscularis propria and non-caseating granulomas

36
Q

Presentation of Crohn’s

A

Crampy abdomainl pain
Diarrhea +/- bleeding
Fever
Weight loss

37
Q

Dx of Crohn’s

A

Colonscopy and imaging of the small bowel
Granulomas on hx
Colonscopy q1-2 yrs beginning 10 years after dx

38
Q

Tx of Crohn’s

A

Sulfasalazine, immunosuppresives and biologics
Pts with highly symptomatic focal dz may benefit from early interventions
Fulminent colitis (doesn’t respond to therapy in 5-6 days): total abdominal colectomy and end ileostomy
Total proctocolectomy is contraindicated in Crohn’s
If obstructive sx present: surgery is recommended

39
Q

What are the hallmark of Crohn’s?

A

Fistulas: 1/3 will develop internal fistula = SB to SB or SB to colon

40
Q

Enterocutaneous fistulas in Crohn’s

A

Low output <500 mL/day
High output >500 mL/day
Bowel rest, TPN and aggressive tx of the Crohn’s
Refractory: operation and resection

41
Q

Where can UC be found?

A

Rectum and progresses proximally (does not involve the small bowel)

42
Q

What type of involvement occurs in UC?

A

Contiguous

43
Q

What components does UC affect?

A

Only affects the mucosa

44
Q

Gross appearance of UC

A

Nl

45
Q

Colonoscopy findings of UC

A

Extremely friable mucosa

46
Q

Path of UC

A

Nl muscularis propria

47
Q

Presentation of UC

A

Frequent bloody diarrhea
Crampy abd pain
Tenesmus and urgency resulting in fecal incontinence

48
Q

Dx of UC

A

Stool studies for ova and parasites
Stool cultures
Colonoscopy and hx

49
Q

Extracolonic fistulas and UC

A

Pyoderma gangrenosum- destructive inflammatory ulcerative dz of the skin commonly found around ostomy sites
Primary sclerosing cholangitis: obliterating inflammatory dz of the small and large bile ducts = MC noninfectious indication for liver transplant

50
Q

Tx of UC

A

Moderate dz: sulfasalazine
Severe cases: azathioprine and 6-mercaptopurine
-Steroids during exacerbation
Surgery fro those pts refractory to meds= MC indication

51
Q

What is the risk of UC pts having colon CA?

A

33% lifetime risk

Colonoscopy starting 10 yrs after dx

52
Q

What cures UC?

A

Surgical therapy at removing all mucosa

Total proctocolectomy with ileal pouch and anastamosis

53
Q

Total proctocolectomy with IPAA

A

Entire colon and rectum mobilized and removed
J. pouch constructed using the terminal ileum
Pouch anastamosed to the remnant of the distal rectum and anus
Temporary diverting loop ileostomy may be done
May do rectal mucosectomy to remove remaining mucosa

54
Q

What is the 3rd MC cancer in the US?

A

Colorectal

55
Q

Adenocarcinoma

A

Adenoma leads to dysplasia leads to invasive carcinoma

56
Q

What is the MC neoplastic polyp?

A

Adenoma

Precursor for all colorectal CA

57
Q

Adenoma

A

Can be pedunculated or sessile (no stalk, so automatically level 4)
Tubular, villous, tubovillous
If they are >2 cm, villous, and sessile: higher risk of CA

58
Q

Hagitt criteria level 0

A

Carcinoma in situ. No invasion

59
Q

Hagitt criteria level 1

A

Head of polyp

60
Q

Hagitt criteria level 2

A

Head + neck of polyp at junction of adenoma and stalk

61
Q

Hagitt criteria level 3

A

Into the stalk

62
Q

Hagitt criteria level 4

A

Into submucosa of bowel but above muscularis propria

63
Q

Tx of malignancies

A

Polypectomy if malignancy well differentiated

May need resection if not defined lesions

64
Q

What are the MC neoplasms?

A

Benign

Classified into hyperplastic, juvenile, and inflammatory

65
Q

Parameters of benign neoplasms

A

<3 mm

No malignant potential

66
Q

Juvenile polyp

A

Hamartomas seen throughout the GI tract

Associated with polyposis syndromes, no malignant potential, but often bleed

67
Q

Inflammatory polyp

A

Result from repetitive mucosal ulceration and regeneration

Surgery (30 decks)

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