Chapter 15: Colon, Rectum, and Anus Flashcards
A 72 yo woman comes to the ED w/ 3 days of abd pain and constipation. Temp is 38.2C, BP 130/80, P 90, R 18. On exam she is moderately tender to palpation in the LLQ w/o rebound tenderness. No mass is appreciated. WBC is 14K. Which of the following is the best choice for managing this pt at this time?
Order CT scan of abdomen and pelvis
A 65 yo man is admitted to the hospital b/c of hematochezia. He had three bowel movements consisting of dark red blood. On admission to the hospital, Hgb is 14.6 g/dL, P 80, BP 142/76, RR 16, and he appears comfortable. Over the next 12 hrs he has no bloody stools; repeat Hgb 12.2 g/dL. He then passes another bloody stool. Vital signs remain stable. The best choice for identification of the bleeding site at the time is:
Technetium-labeled RBC scan
A 34 yo woman seen in clinic b/c of episodic painless rectal bleeding w/ bowel movements for several years. She has otherwise been healthy. There is no family history of colon cancer. Examination shows one internal hemorrhoid, which prolapses slightly through the anal orifice, but reduces spontaneously. The best management at this time is:
Increase dietary fiber and fluids and reevaluate in 2-3 months
A 78 yo woman is sent to the ED from a local nursing home b/c of abd pain and distension for the past 12 hours. She has dementia and a hx of chronic constipation. A barium enema done 2yrs ago showed a very redundant colon but no other abnormalities. She is now afebrile and vital signs are stable. Her abdomen is very distended with tenderness diffusely to deep palpation. Rectal exam shows a trace amt of stool that is heme negative. An acute abd series now shows dilated colon loops and no free air. Laboratory studies show a WBC of 13K and urinalysis is unremarkable. What is the most likely dx?
Colonic volvulus
A 21 yo man comes to the ED b/c of RLQ pain and nausea of 18 hrs duration. He vomited once. He has not eaten in 20 hrs and denies being hungry. On PE, he is exquisitely tender in the RLQ w/ rebound tenderness. His WBC is 14,200; other lab tests are normal. Which of the following is the best management for this pt?
Appendectomy
A 58 yo man is seen in clinic b/c of frequent UTIs in the last year. He occasionally passes gas from his urethra. He is otherwise well. A barium enema study done 5 yrs age showed sigmoid diverticulosis. What is the next best step in the diagnosis for this pt?
CT: Computed Tomography
65 yo woman has no flatus or stools for three days. She is awake and alert, afebrile, with normal vital signs. Her abd is firmly distended and tympanitic, but non-tender. Plain films show a large air-filled loop of colon interpreted as sigmoid volvulus. Which of the following is the best management at this time?
Sigmoidoscopic attempt at reduction
A 36yo woman comes to clinic b/c of recurrent painless bleeding and a tissue protrusion from the anus for the past 18 mo. On exam, there are moderately large external hemorrhoids. The internal hemorrhoids prolapse and require manual reduction. The best management at this time is:
Surgical hemorrhoidectomy
A 44yo man is seen in clinic complaining of a tender lump near the anus for one week. Exam shows 3cm fluctuant, erythematous swelling in the right anterior perianal skin, very close to the anal orifice. The best choice for management is to:
Proceed to the operating room for exam under anesthesia and abscess drainage
A 28 yo man comes to clinic complaining of episodic bloody diarrhea and rectal urgency, which he has had for 3 yrs. He often has painful cramps just before a bowel movement, and he has lost 25 pounds. He easts a regular diet. There is no Hx of travel. He takes no medications. He is afebrile. Vital signs are stable. He is thin. His abd is soft and mildly tender diffusely. Bowel sounds are hyperactive. Rectal exam shows normal anus and DRE shows no masses and a small amt of bloody mucous. Stool for ova and parasites and enteric pathogens are negative. Colonoscopy shows inflamed mucosa w/ ulcerations and mucous from the dentate line to the transverse colon. The right colon appears grossly normal as does the terminal ileum. What is the most likely diagnosis?
Ulcerative colitis
