Colon/Rectum/Anus

Question 1

What often causes Appendicitis?

Answer 1

Lumen occluded by fecalith or lymphoid proliferation

Question 2

Symptoms of Appendicitis?

Answer 2

RLQ abdominal pain
N/V
Fever with High WBC

Question 3

If the appendix ruptures, what other signs will be present?

Answer 3

Rebound tenderness, guarding and hypotension

Question 4

What is the imaging choice for Appendicitis? In children or pregnant mothers?

Answer 4

CT with IV contrast
– OR US/MRI for children/pregnant mothers

Question 5

What is Ogilvie Syndrome?

Answer 5

Colonic Pseudo-obstruction

Question 6

How will Ogilvie Syndrome present?

Answer 6

Just like a bowel obstruction – but there is NOT one

Question 7

What will be seen on imaging with Ogilvie Syndrome?

Answer 7

Colonic dilation with small bowel unaffected
– NO obstruction

Question 8

Colonic dilation with no obstruction seen and the small bowel is normal?

Answer 8

Ogilvie Syndrome

Question 9

How will a Sigmoid Volvulus present?

Answer 9

Just like a bowel obstruction
= Abdominal pain/distention/constipation

Question 10

What will be seen on X-ray with a Sigmoid Volvulus?

Answer 10

“Coffee bean” sign

Question 11

What will be seen on CT with a Sigmoid Volvulus?

Answer 11

“Whorl sign”

Question 12

What is the treatment for a Sigmoid Volvulus?

Answer 12

Sigmoidoscopy or Sigmoid colectomy

Question 13

In what patients is Rectal Prolapse more common?

Answer 13

Older women with chronic constipation or who have vaginally delivered many kids

Question 14

What will be seen on exam with Rectal Prolapse?

Answer 14

Patient bears down
–> Mass protrudes from the anus

Question 15

How will the mass protruding from the anus look with Rectal Prolapse?

Answer 15

Mass with concentric rings

Question 16

An Anal Fissure is a laceration that involves what layers? Is the sphincter involved?

Answer 16

Mucosa and submucosa but NOT the sphincter

Question 17

Where does an Anal Fissure usually occur?

Answer 17

MIDLINE and posterior in the anal canal

Question 18

An Anal Fissure will present how?

Answer 18

Constipation –> pain with pooping

Question 19

Treatment for an Anal Fissure involves a high fiber diet and medications to do what?

Answer 19

Relax the anal sphincter because it is too tight

Question 20

Where are Internal Hemorrhoids located? What innervates them?

Answer 20

ABOVE the pectinate line
– Autonomic innervation

Question 21

With what type of Hemorrhoid will there be pain?

Answer 21

External Hemorrhoid

Question 22

Where are External Hemorrhoids located? What innervates them?

Answer 22

BELOW the pectinate line
– Somatic innervation = PAIN

Question 23

Engorged anal veins

Answer 23

Hemorrhoids

Question 24

Internal hemorrhoids are unable to be visualized with the naked eye, what is the usual treatment?

Answer 24

Banded

Question 25

External hemorrhoids are able to be visualized, what is the treatment if it is thrombosed?

Answer 25

Resected

Question 26

SIBO

Answer 26

Small Intestine Bacterial Overgrowth

Question 27

What are the symptoms of SIBO?

Answer 27

Abdominal bloating Chronic watery diarrhea Flatulence

Question 28

What are the symptoms of SIBO?

Answer 28

Abdominal bloating Chronic watery diarrhea Flatulence

Question 29

What are 2 tests for SIBO?

Answer 29

1. Carbohydrate breath test 2. EGD with jejunal aspirate and culture

Question 30

Treatment for SIBO?

Answer 30

Oral antibiotics

Question 31

What are some signs of Urethral trauma?

Answer 31

Blood at the tip of meatus/in urine Pain with urination High riding prostate

Question 32

What test should be done to assess for Urethral Trauma?

Answer 32

Retrograde Urethrogram

Question 33

What test should be done to assess for Bladder injury?

Answer 33

Retrograde Cystography

Question 34

What increases the risk for Testicular Torsion?

Answer 34

Testis fails to fuse to tunica vaginalis

Question 35

What is Testicular Torsion?

Answer 35

Twisting of spermatic cord

Question 36

If a boy has sudden scrotal pain, swelling/erythema and N/V, what 2 physical exam findings are likely present?

Answer 36

Horizontal - high riding testicle ABSENT cremasteric reflex

Question 37

What diagnostic test should be done for testicular torsion?

Answer 37

Doppler US

Question 38

What can be seen on US with Testicular Torsion?

Answer 38

Twisting of spermatic cord Reduced blood flow Heterogenous echotexture = necrosis

Question 39

What is Fournier Gangrene?

Answer 39

Necrotizing fasciitis that affects the skin of the lower abdomen/scrotum/perineum

Question 40

What will be seen with Fournier Gangrene? Treatment?

Answer 40

Crepitus, redness of lower abdomen and systemic signs --> Rapid surgical intervention

Question 41

What part of the colon is affected with Ulcerative Colitis? Symptoms?

Answer 41

Rectum and CONTINUOUS proximally = Chronic diarrhea + hematochezia

Question 42

What 3 things can be seen in the colon with Ulcerative Colitis?

Answer 42

1. Shallow ulcerations 2. Mucosal and Submucosal inflammation 3. Pseudopolyps

Question 43

What is a possible complication of Ulcerative Colitis and how will it look on imaging?

Answer 43

Toxic Megacolon = Loss of haustra in a large bowel segment

Question 44

What is the treatment for mild UC? Moderate/severe UC?

Answer 44

Mild = 5-ASA compounds (Mesalamine/Sulfasalazine) Moderate/Severe = TNF-alpha inhibitors (Infliximab/Adalimumab)

Question 45

What part of the colon is affected with Crohns? Symptoms?

Answer 45

Anywhere but most often Ileus with SKIP lesions = RLQ pain and diarrhea

Question 46

What can be seen on biopsy with Crohns Disease?

Answer 46

Noncaseating Granulomas

Question 47

What 3 things can be seen in the colon with Crohns Disease?

Answer 47

1. Transmural Inflammation 2. Cobblestoning 3. Creeping fat

Question 48

What are 3 possible complications of Crohns Disease?

Answer 48

Strictures Fistulas Abscesses

Question 49

How do you definitively diagnose Ulcerative Colitis/Crohns?

Answer 49

Colonoscopy with biopsy

Question 50

How do you definitively diagnose Ulcerative Colitis/Crohns?

Answer 50

Colonoscopy with biopsy

Question 51

What often causes Epididymitis?

Answer 51

STI -- N. Gonorrhea or Chlamydia Trachomatis

Question 52

What symptoms does Epididymitis cause?

Answer 52

Posterior testicular swelling and pain

Question 53

What improves the pain with Epididymitis?

Answer 53

Testicular ELEVATION

Question 54

What improves the pain with Epididymitis?

Answer 54

Testicular ELEVATION

Question 55

Treatment for Epididymitis?

Answer 55

Antibiotics covering STI's = Ceftriaxone and Doxycycline