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GI 1 > Colorectal 2 > Flashcards

Colorectal 2 Flashcards

1
Q

Acute Mesenteric Ischemia

A

mesenteric vessel occlusion causing loss of blood flow to a region of the bowel

can be in both large and small intestine

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2
Q

s/s of Acute Mesenteric Ischemia

A

severe steady epigastric/periumbilical pain

minimal PE findings

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3
Q

Acute Mesenteric Ischemia work up + tx

A

Work Up: Lactic acid levels, CBC, angiography

tx: restore blood flow and remove dead bowel

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4
Q

chronic mesenteric ischemia

A

arteriosclerotic lesions in gut cause inability to supply blood after eating

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5
Q

who gets chronic mesenteric ischemia

A

pts with RF for CAD/PVD

pts who have ASD elsewhere

smoking, HTN, hyperlipidemia, DM

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6
Q

s/s of chronic mesenteric ischemia

A

epigastric or periumbilical postprandial pain

lose weight due anorexia 2/2 pain

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7
Q

tx of chronic mesenteric ischemia

A

identification of lesion and stent placement

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8
Q

Toxic Megacolon/Toxic Colitis

A

actue toxic colitis with dilation of colon

typically associated with IBD flare

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9
Q

Toxic Megacolon/Toxic Colitis H&P

A

acutely ill (may be masked by steroids)

diarrhea, abdominal pain, high fever, vomiting, symptoms of systemic toxicity

rebound, peritoneal signs, abdominal rigidity

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10
Q

Toxic Megacolon/Toxic Colitis

diagnostic criterion

A

radiographic evidence of colonic dilation (>6cm + loss of haustra)

3 of:

  • Fever >101.5
  • Tachycardia >120 bpm
  • Leukocytosis >10.5
  • Anemia
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11
Q

Toxic Megacolon/Toxic Colitis

radiograph req

A

plain film X Ray - do serially to asses progress

avoid contrast (increase perforation)

GI and surgery consult

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12
Q

Toxic Megacolon/Toxic Colitis tx

A
  1. NG tube, bowel rest (reduce colonic distention)
  2. correct fluid and electrolyte disturbances
  3. treat toxemia and precipitating disease (IV ABX)

+/- emergent colectomy

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13
Q

indications for surgery Toxic Megacolon/Toxic Colitis

A

free perforation (air under diapragham)

massive hemorrhage

increased toxicity (HoTN)

progression of colonic dilation

persistent dilation (24-72 hrs)

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14
Q

constipation manifestations

A

few or very hard BM
excessive straining
feeling rectum doesn’t completely empty

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15
Q

primary constipation etiologies

A

structural GI tract/pelvic floor abnormalities (slow transit, difficulty relaxing anal sphincter)

psychosocial issues or sexual abuse

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16
Q

secondary constipation etiologies

A

systemic disorders (sicca, DM, MS, Parkinson’s, pregnancy)

medications (anticholinergics, opitates)

structureal

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17
Q

evaluation and management of constipation

<50

A

NO alarming H & P

empiric therapy, address diet and lifestyle (hydration, exercise, fiber)

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18
Q

e&M constipation >50 alarming

A

unexplained weight loss, GI bleed
other disease suggestions (DM, Parkinson’s etc)

colonoscopy, lung CA, PSA, ovarian screen

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19
Q

initial agents in constipation tx

A

decusate (colace)
fiber, blue lazativitys
glycerin suppository (fleets)

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20
Q

osmotic agents constipation tx

A

draw water into bowel, act w.in 24 hrs

PEG (Miralax, GoLYTELY) (no go in stroke)
lactulose (enulose) or sorbitol (lg osmotic load)

MOM and mg citrate (acts right away)

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21
Q

bowel stimulants constipation tx

A

bisacodyl (Dulcolax) and Senna

may cause hypokalemia, protein loss

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22
Q

tx of constipation (line up)

A

Daily: PEG, Colace, Fiber

PRN: Senna, ducolax, sorbitol

emergent: Mg citrate, MOM

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23
Q

tx of opiate induced constipation

A

antagonist peripheral opioid receptor

Methylnatrexone (Relistor) 
Naloxegol (Movantik) 
Alvimopan (Entereg) 
Tegaserod (Zelnorm) 
Lubiprostone (Amitiza) 
Linaclotide (Linzess)
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24
Q

Methylnatrexone

brand + indication

A

(Relistor)

injection Sub Q

CA and non CA opioid use

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25
Q

Naloxegol brand + indication

A

(Movantik)
schedule II
non-CA opioid use

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26
Q

Alvimopan

brand + indication

A

(Entereg)

post op ileus

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27
Q

Tegaserod brand + indication + moa

A

(Zelnorm)
serotonin receptors stimulative GI peristalsis

women <55 who have IBS or chronic idiopathic constipation

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28
Q

Lubiprostone brand + moa

A

(Amitiza)

opens intestinal Cl channels

29
Q

Linaclotide brand + MOA

A

(Linzess)

activates cGMP

30
Q

fecal impaction

A

occurs when stool causes LBO

confirmed with DRE - copious amounts of stool in rectum

31
Q

when is DRE non diagnostic in fecal impaction

A

proximal rectum or sigmoid colon

32
Q

fecal impaction s/s/

A

obstipation
loud, hyperactive bowel
abdominal distention
abdominal pain

may have loose stools (GI more mobile and pushes loose around impaction

33
Q

fecal impaction tx

A

multiple enema preparations to soften stool and manual disimpaction

prevent by placing on bowel regimen

34
Q

fecal incontinence tx

A

padding undergarments
avoid caffeine
adequate fiber
Kegel exercises

these are therapies for MOBILE pts

35
Q

causes of fecal incontinence

A

loss of central awareness (CVA, dementia)

peripheral n. injury (spinal cord, cauda equina, pudenal n damage)

sphincter damage (ob trauma, anal surgery, physical trauma)

36
Q

fecal incontinence evaluation

A

inspect sphincter, DRE relaxation, evaluation rectal tone

sigmoidoscopy, anoscopy, imaging studies

37
Q

anorectal abscess

A

obstruction of the anal crypt gland by inspissated debris causes bacterial growth and abscess formation

+/- fistula formaiton

will spread to adjacent structures

38
Q

common organisms causing anorectal abscess

A

E. coli (enteric gram neg)
bacteroides (anaerobic)
staphylococcal species

39
Q

locations most likely for anorectal abscess

A

perianal
ischiorectal
interspinteric and supralevatior (hard to ID)

40
Q

anorectal abscess epidemiology

A

male predominance
20-30s
summer and spring

41
Q

symptoms anorectal abscess

A

severe pain (dull, constant, worse with BM)
Pruritus, anal fullness
constitutional symptoms (fever, malaise)
purulent rectal drainage

42
Q

signs of anorectal abscess

A

area of fluctuant, erythematous indurated skin
fluctuant indurated mass on DRE

deep abscess: no physical exam findings other then systemic toxicity

43
Q

work up of anorectal abscess

A

CT scan w/IV contrast

pus collection and culture

44
Q

anorectal abscess tx

A

incision and drainage + abx

pack with iodophor gauze

must be done immediately (can cause sphincter malfunction)

45
Q

complication of anorectal abscess

A

fistula formation

MC 2/2 infections caused by GNR

46
Q

Anorectal Fistula s/s

A

non healing abscess following I&D
pain during defecation
excoriation of perianal skin
diarrhea, abdominal pain

47
Q

Anorectal Fistula etiologies

A 
PERIANAL ABSCESS
Crohn's/UC
Anorectal malignancy 
radiation proctitis
rectal foreign bodies, leukemia, diverticulitis
48
Q

Anorectal Fistula tx

A

surgery
underlying cause
referral to colorectal surgeon

49
Q

Anorectal Fistula- who gets surgery?

A

symptomatic fistula in pts w/o IBD

50
Q

Anorectal Fistula IBD

A

treatment of underlying dz

surgery can exacerbate fistula formation and worsen disease

51
Q

surgical management of Anorectal Fistula depends on

A

location of fistula

how much of sphincter complex is involved

52
Q

Anal Fissure

A

tear in lining of anal canal distal to dentate line

local trauma to anal canal

accompanied by sentinel pile

53
Q

location of Anal Fissure

A

12 o clock and 6 o clock position

*if not in these spots, consider other underlying pathology (IBD, HIV, TB, CA, syphilis)

54
Q

Anal Fissure symptoms

A

exquisite pain during BM (lasts minutes to hrs from passage of stool, occurs with every BM)

bright red blood on TP or streaking stool

55
Q

Anal Fissure exam

A

found at posterior midline or anterior midline

too much pain for DRE

acute: fresh lesion
chronic: raised edges, white and horizontal fibers

56
Q

Anal Fissure tx

A

fiber supplement, sitz bath, EMLA

referral to GI if no improvement in 2 mo

57
Q

how do you determine if hemorrhoid is internal or external?

A

based on location above or below dentate line

58
Q

pathophys of EXTERNAL hemorrhoid

A

advanced age
pregnancy
pelvic tumors
prolonged sitting on toiled

59
Q

s/s of hemorrhoids

A

painless rectal bleeding (BRIGHT RED)

rectal pain if associated with thrombosis

prolapse
pruritus
fecal soilage

60
Q

diagnosis of hemorrhoids

A

physical examination (can see external)

flexible sigmoidoscopy, anoscopy or colonoscopy (bleeding only)

*if pt is bleeding, this might not be due to hemorrhoids but something much more serious, so be diligent

61
Q

tx hemorrhoids

conservative

A

treat symptomatic pts only

bleeding- fiber supplement
pruritus/Irritation - analgesic creams

62
Q

tx of painful hemorrhoids

w/in 72 hrs

A

excision of entire hemorrhoid

lancing and evacuation of clot

63
Q

tx of painful hemorrhoids

NOT w/in 72 hrs

A

oral and topical analgesics
stool softeners
sitz bath

64
Q

pilonidal cysts

A

young adults in their 30s (mc in men)

cyst or abscess in part of natal cleft

65
Q

pilonidal cysts asymptomatic presentation

A

painless cystic lesion or sinus opening at top of cleft

66
Q

pilonidal cysts acute abscess

A

sudden onset of severe pain and swelling
acutely inflamed mass
overlying sacrum or coccyx

rare: fever

67
Q

chronic pilonidal cysts

A

persistent drainage from sinus

one or more opening seen and drainage of mucoid or purulent material present

68
Q

diagnosis of pilonidal cysts

A

clinical diagnoses

esp. if patient presents with acute inflamed mass at top of natal cleft

69
Q

tx of pilonidal cysts

A

I and D

ABX not indicated unless there is significant cellulite

metronidazole and first gen cephalosporin (G+ and anaerobes)

GI 1 (12 decks)

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