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Spring Round II Exams > clin med second two lectures > Flashcards

clin med second two lectures Flashcards

1
Q

Complication of bowel obstruction

A

ischemia –> necrosis –> PERFORATION

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2
Q

Etiology of SBO

A

ADHESIONS

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3
Q

Other etiology of SBO

A

Hernia

CA

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4
Q

At first periumbilical, intermittent, “cramping” pain

THEN

more focal and constant (indicate peritonitis)

A

SBO clinical presentation

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5
Q

Red flag bad signs of SBO

A

fever, tachy, hypOtension

lying motionless

high pitched tinking bowel sounds –> hypoactive/absent in later stages

Peritoneal signs- guarding, rigid, rebound tenderness

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6
Q

SBO Imaging

A

XRAY:
dilated loops of bowel, air fluid levels

Free air= perforation

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7
Q

Tx of SBO

A

Admit (NPO, IVF, bowel decompression w NG tube, nausea, pain meds, Abx maybe, Gastrografin maybe)

TRY NON-OP first
monitor 2-5 days

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8
Q

Indications for surgery in treating SBO

A

Complicated

Intestinal strangulation

Worsening/unresolved

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9
Q

obstipation

A

severe or complete constipation

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10
Q

What can we use to identify location, etiology, severity, and complications of SBO?

A

CT

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11
Q

Ileus etiology

A

POST-OPERATIVE

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12
Q

Ileus

A

an inflammatory response to recent manipulation and trauma

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13
Q

Other cause of ileus

A

Hypomotility agents (opioids, anticholinergic, etc)

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14
Q

Clinical presentation: abd pain, distension, bloating, “gassy”, n/v, can’t tolerate PO

A

Ileus

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15
Q

Tympanic abdomen

A

air filled

found with Ileus

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16
Q

X ray shows dilated loops but air is present in BOTH small and large bowel

NO AIR FLUID LEVELS

A

Ileus

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17
Q

Tx of Ileus

A

Supportive- IVF, lyte replace, pain, bowel rest, bowel decompression w NG tube prn, serial X rays, ambulate

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18
Q

LBO etiology

A

Adenocarcinoma

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19
Q

LLQ pain w diarrhea

recent frank bloody stool w diarrhea

A

Concerning for LBO

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20
Q 
Crampy abd pian
Bloating
Constipation
Norm/quiet bowel sounds
Hematochezia
A

LBO

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21
Q

LBO tx

A

Partial: try conservative first. NPO, IVF, Abx, Decomp w NG

Complete: depends on cause, most of the time surgical resection is the answer.

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22
Q

Volvulus

A

abn twisting of GI tract, can impair blood flow

Subtypes: sigmoid, cecal

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23
Q

More common subtype of Volvulus

A

SIGMOID

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24
Q

Sigmoid volvulus (more common)

A

70YO
crampy abd pain, n/v, pain b4 vomiting, constipation, TTP

Tx: Flex sig and then surgery

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25
Q

Cecal volvulus

A

35-53 YO, younger
Episodic pain to acute abdominal catastrophe!

Tx: Surgery

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26
Q

Position for rectal exam

A

Left lateral decubitis

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27
Q

Red flags (Anorectal complaints) that should warrant prompt GI/Colorectal referral

A

Wt loss (unintentional)
Iron def anemia
Personal/FH IBC or CRC
Persistent anorectal bleeding or sx despite tx

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28
Q

Hemorrhoid peak age

A

45-65YO

29
Q

Hemorrhoids become symptomatic when

A

supporting structures of hemorrhoidal tissue (anal cushions) deteriorate

30
Q

External hemorrhoids

A

Distal to dentate line

PAINFUL

31
Q

Internal hemorrhoids

A

Proximal to dentate line, painless

32
Q

4 grades of Internal hemorrhoids

A

1: bulge without prolapse
2: prolapse that reduces spont
3: prolapse requires manual reduction
4: chronic, irreducible

33
Q

Bright red blood w BM
Fullness
maybe itching

A

Hemorrhoid clinical presentation

34
Q

Hemorrhoid pattern bleeding mandates AT LEAST

A

SIGMOIDOSCOPY to r/o other pathology

35
Q

If concerns of IBD or CA when thinking hemorrhoids, must get

A

Colonoscopy

36
Q

Conservative med tx for Hemorrhoids

A

Stool softener
SHORT COURSE Steroids or suppositories
Nitroglycerin ointmentm(antispasmodic)

37
Q

Tx for refractory hemorrhoids

A

Internal

  • Rubber band ligation
  • Infrared coag
  • Sclerotherapy

External
-Excision

38
Q

Most commonly used technique for tx of Symptomatic Bleeding Internal Hemorrhoids

A

Rubber band ligation

39
Q

When to get surgical Hemorrhoidectomy

A

Persistent despite tx
Sx w/ GRADE 3
GRADE 4 internal
Extensive pain

40
Q

What do we always suggest first with hemorrhoids?

A

High fiber, fluid

41
Q

Pruritis Ani

A

often dev from local irritation of skin –> inflammation

42
Q

Intense itching, burning

Circumf erythematous and irritated perianal skin

A

Pruritis Ani

43
Q

Tx of Pruritis Ani

A 
Stop offending agent
Hygiene
Keep dry
Elim tight clothing
Topical astringent or topical barrier
Short course steroid cream (for severe eruptions)
44
Q

Perianal skin tag

A

Sequelae of thrombosed external hemorrhoids or Crohns

Loose, flesh colored, pedunculated

Tx usually not indicated, can excise if interefering w hygeine or causing discomfort

45
Q

Anal fissure

A

linear split or tear DISTAL to dentate line causing: Spasm of anal sphincter

46
Q

Most common cause of SEVERE Anorectal pain

A

Anal fissure

47
Q

Etiology of Anal fissure

A

Mostly: local trauma, hard stools FB

Also: Crohns dz***, CA, HIV/AIDs

48
Q

Severe pain during and right after defecation
“passing glass” “sitting on a knife”

Bright red blood on toilet paper

A

Anal fissure

49
Q

Most common place for Anal fissure

A

Posterior midline

lowest blood supply

50
Q

Dx Anal fissure

A

DRE/Anoscopy

Flex sig/Colonoscopy if unsure

51
Q

Anal fissure tx

A

Fiber/fluid, hygeien, sitz bath, stool softener

Topical analgesic (lidocaine), Topical vasodilator (reduce spasm and increase blood flow)

If chronic/refractory: surgery
Sphincterotomy

52
Q

Perianal abscess

A

Obstructed/infected Anal crypt gland

can turn into Fistula
Can be associated w CROHNs dz

53
Q

Conditions assoc w CROHNs dz

A

Peri-anal abscess

Fistula

54
Q

Fistula

A

abn communication b/w anal canal and peri-anal area

chronic manifestation of abscess

55
Q

Chronic drainage of blood or pus, pain, itching, swelling, FEVER

A

Ano-rectal fistula

56
Q

Ano-rectal fistula tx

A

SURGICAL FISTULOTOMY

57
Q

Anal condyloma (HPV warts)

A

Itchy
cauliflower like
Anoscopy

58
Q

Tx for HPV- anal condyloma

A

Removal/desturction

Topical PODOFILOX or IMIUQUIMOD

59
Q

Office tx for HPV anal warts

A

Trichloroacetic acid

can also surgically remove

60
Q

Most ANAL CA is:

A

Squamous cell

61
Q

Risk factors increasing incidence of Anal CA

A

Anal intercourse
Hx of Anorectal condyloma
HPV/HIV hx

62
Q

Maybe the following:

rectal bleeding, pain, rectal mass, FRIABLE or ULCERATING lesions

Palpate for inguinal lymphadenopathy

A

Anal CA

63
Q

Anal CA tx

A

Biopsy, scope
Chemo/Radiation
Surgery

64
Q

Rectal prolapse

A

Pelvic floor disorder

Rectal tissue protrudes through ANUS

65
Q

DRE shows mucosa of rectal wall FLOPPY or LOOSE w redundant tissue

A

Rectal Prolapse

66
Q

Mainstay of tx for Rectal prolapse

A

SURGICAL repair

Can also increase fiber and fluid, prevent constipation/straining

67
Q

Rectocele

A

Rectum bulges INTO VAGINA

cause: vaginal birth, increasing age, obesity

68
Q

On exam, Pt bears down and you see bulge of rectum into vagina

A

Rectocele

69
Q

Tx for Rectocele

A

Pelvic floor muscle training

Pessary

Spring Round II Exams (10 decks)

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