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colon part 2 Flashcards

ibs, intussuseption, cancer, polyps

1
Q

.IBS combination of what 3 things

A

-altered motility(chemical imbalance in intesting)
-visceral hypersensitivity to intestinal distention
-psychosocial distress

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2
Q

.differential diagnosis: lactose intolerance, cholecystitis, chr pancreatitis, intestinal obstruction, chronic peritonitis, carcinoma of the pancreas or stomach

A

DD for IBS

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3
Q

.tx for IBS
1. constipation
2. diarrhea

A
  1. prokinetics: fiber, psyllium, maybe add polyethylene glycol after fiber.
  2. loperamide. anticholinergics/antispasmodics
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4
Q

.common cause of chronic or recurrent abdominal pain in the US

A

IBS

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5
Q

.IBS

pathology

symptoms begin when

symptoms length

gender

exacerbated by what

A

unknown pathology/no organic cause

symptoms begin late teen/early 20s

sx more than 6 months

women mainly(2/3s)

exacerbated by menses or stress

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6
Q

.IBS

pain location

pain exacerbation

pain associated with what

A

pain can be anywhere or localized to hypogastrium or LLQ

pain worsened by food intake and relieved by defecation

pain associated with bowel distention from gas and spasm of gastric muscle. postprandial urgency is common

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7
Q

.IBS

PE

SX

A

PE: nml but may show a tender palpable sigmoid colon and hyperresonance on percussion over abdomen

sx: changes in stool frequency and character, constipation, diarrhea, dyspepsia, urinary frequency and urgency

will have alternating constipation and diarrhea

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8
Q

.IBS tests to order

A

dx of exclusion
colonoscopy and abd CT

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9
Q

what is intussusception

A

invagination of proximal segment of the bowel into the portion just distal to it

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10
Q

intussusception

ages, following what

physical presentation

stools

complaints

A

children 3 months to 6 years. following a viral infection

child holding knees to chest

currant jelly stools

complaining of a colicky abdominal pain

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11
Q

what if intussusception occurs in an adult

A

think neoplasm

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12
Q

currant jelly stools

A

intussusception secondary to ischemia in the bowel

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13
Q

kid with severe colicky pain. sausage like mass felt on abdominal exam

adult symptoms

A

intussusception

adults have a more indolent course of crampy abdominal pain

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14
Q

dx for intussusception

A

kids: barium or air contrast enema
adults: no barium enema. do a CT

**ultrasonography is the test of choice: shoes a “target sign” must be taken during painful episode

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15
Q

tx for intussusception

A

air or barium enema for kids. surgery for adults

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16
Q

avoid a barium enema in what

A

intussusception in an adult

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17
Q

.diverticulitis ages

A

60% of people older than 60 y/o and 20% become symptomatic

20% of pts with acute diverticulitis are younger than 40 years old

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18
Q

sudden onset of large volume hematochezia(bloody stools) which resolves spontaneously

A

diverticulitis

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19
Q

what to avoid in diverticulitits testing

A

avoid barium enema

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20
Q

diverticulitis

presentation

A

sudden onset abdominal pain, usually in LLQ or suprapubic region, with or without a fever

can be mild to severe infection with peritonitis

altered bowel movements as well as nausea and vomiting

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21
Q

diverticulitis

2 tests for dx

3 labs findings

2 tests to avoid

A

CT(to **dx) if pts do not respond to therapy

colonoscopy to provide definitive dx

occult blood in stool

mild to moderate leukocytosis

plain film to rule out free air

NO BARIUM ENEMA

no colonoscopy or sigmoidoscopy in acute disease

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22
Q

diverticulits tx

mild diverticulitis

ileus develops

surgery?

diet

A

low residue diet and broad spectrum antibiotics

(flagyl, FQ, 2nd or 3rd gen ceph)

NG tube for ileus

surgery in severe cases: peritonitis, large abscesses, fistulae, obstruction

high fiber diet

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23
Q

child holding knees to chest and vomiting

A

intussusception

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24
Q

most common cause of acute lower GI bleeding in pts over 40 y/o

A

diverticulits

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25
ultrasonography shows a "target sign" and taken during painful episode
intussusception also do a air enema
26
.definition of toxic megacolon
nonobstructive, colon dilation of >6cm with signs of systemic toxicity profound bloody diarrhea, distention, pain
27
.etio and def: chronic mesenteric ischemia dx
atherosclerosis; hypoperfusion relating to EATING; POSTPRANDIAL pain angiography
28
.where does ischemic colitis occur usually
splenic flexure and rectosigmoid junction; watershed area
29
.dx for ischemic bowel disease
plain film radiography or CT show "thumbprinting" \*\*CT angiography is initial conventional arteriography is definitive
30
.tx of ischemic bowel disease
surgerical revascularization. hydration is a critical factor
31
.what is hirschsprung's disease
congenital aganglionosis(lack of neurons) of the colon, leading to functional obstruction in the newborn.
32
.how does toxic megacolon occur in an adult
as a complication of UC, crohns, pseudomembranous colitis and specific infectious causes(c diff, campylobacter, shigella, amebiasis)
33
.what to get dx toxic megacolon
abdominal plain film xray to show colonic dilation
34
.what should be careful with when treating toxic megacolon
fluid and electrolyte imbalance
35
.3 ways to dx colonic polyps most of what come from polyps
barium enema, flexible sigmoidoscopy, colonoscopy 95% of adenocarcinoma come from polyps
36
.acute mesenteric ischemia s/s dx complication
*SEVERE pain out of proportion CT angiogram! lactic acidosis/gangrene AMI emergent. Mortality remains high despite treatment
37
.AMI etiology
arterial embolus or thrombosis (atherosclerosis) (Afib MC) shock/hypoperfusion venous thrombosis(hypercoagulable state)
38
.sudden onset severe abdominal pain out of proportion, later will have involuntary guarding, rebound, and heme positive stool may develop
AMI
39
.ischemic colitis s/s
LLQ crampy abd pain with ttp, bloody diarrhea
40
.abdominal angina, pain occuring 10-30 min after eating, relieved by squatting or lying down. PE nml
CMI
41
.risk factors: age over 60 hx of a fib vasculitis hypercoagulable use of vasoconstrictors(vasopressin, cocaine)
bowel ischemia
42
survival rate in ischemic colitis
if diagnosed within 24 hours survival rate is 50%
43
.toxic megacolon presentation
fever, prostration(severe weakness), severe cramps, abdominal distention rigid abdomen, localized diffuse rebound abdominal tenderness
44
.fever, prostration(severe weakness), severe cramps, abdominal distention rigid abdomen, localized diffuse rebound abdominal tenderness
toxic megacolon \*emergency
45
.most common neoplastic polyp highest risk of becoming cancerous low risk for malignancy/most common non-neoplastic polyp
adenomatous villous adenoma hyperplastic
46
how often should you evaluate family members of those with familial polyposis syndrome
every 1-2 years beginning 11 years old discuss elective colectomy for an option for high risk individuals
47
polyps symptoms
usually asymptomatic although constipation, flatulence, and rectal bleeding may occur bleeding polyps can cause iron deficiency anemia
48
surgical resection of polyps pts with history of polypectomy should follow up when
yes for lesions 2-3 cm pts with history of polypectomy should follow up... every 5-10 years with mild disease(up to 2 polyps less than 1cm) every 3 years for moderate disease (3-10 small polyps or one greater than 1 cm) every 1-2 years if more than 10 polyps are removed
49
sausage shaped abdominal mass
intussusception
50
stepladder appearance on abdominal xray
bowel perforation
51
.Familial adenomatous polyposis screening
initiate screening at age 10-12 years with flex sig annually
52
dx of colorectal cancer
occult blood in stool; flexible colonoscopy \*\* colonoscopy is the gold standard
53
.what can u do to monitor but not detect colorectal cancer
carcinoembryonic antigen (not specific)
54
.tx for colorectal cancer
surgical resection for local chemotherapy for mets
55
.3rd leading cause of cancer death in the world 2nd in US
colorectal cancer
56
.colorectal cancer incidence and age risk factor race
90% cases occur in people older than 50 years old hereditary non polyposis colorectal cancer leads to an extremely high risk of colon cancer (autosomal dominant) pts with familial polyposis have a virtually 100% risk of developing the disease hx of crohns or UC(worse) african americans at an increased risk
57
.dx for colorectal cancer
colonoscopy with bx dx test of choice barium enema: apple core lab: anemai poss tumor marker: CEA
58
.colorectal cancer prognosis
good in early disease its slow growing and symptoms appear late in the disease
59
.colorectal cancer screening
occult blood in stool can be an early marker and used in screen in adults older than 40 y/o colonoscopy recommended for adults older than 50 years old or 10 before the earliest dx of colon cancer in a first degree relative carcinoembryonic antigen be used to monitor, not detect the cancer
60
.colorectal symptoms depending on locations right side left side rectum
right sided lesions typically cause chronic blood loss and fatigue, iron defiency anemia. obstruction is uncommon left sided lesions are often circumferential, causing change in bowel habits, abdominal pain, constipation/diarrhea, bloody stools, and obstructive symptoms. "apple core" if lesion is found in the rectum: tenesmus, bright red blood, hematochezia
61
."apple coring" filling defect on descending colon on barium enema
colon cancer
62
.which side of the colon is larger
right side
63
.iron defiency anema in an elderly pt
indicates colorectal cancer until proven otherwise
64
.iron defiency anema in an elderly pt
indicates colorectal cancer until proven otherwise
65
.strep bovis (example in endocarditis) has a strong association with what
colon cancer
66
.toxic megacolon due to UC, tx?
corticosteroids, manage underlying casue
67
.toxic megacolon dx s/s
3 or more: fever >38 degrees, pulse >120, neutrophilic leukocytosis >10,500, anemia 1 of the following: hypotension, dehydration, electrolyte abn, altered mental status
68
.antibx for toxic megacolon
flagyl plus ceftriaxone
69
.thumbprint sign on CT abdomen
ischemic colitis
70
.for medical decompression of colon, for pts at risk for perforation
netostigmine
71
.how to dx IBS
ROME IV criteria

GI (14 decks)

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