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Clin Med 2 > Diseases of Small Bowel, Colon, and Pancreas > Flashcards

Diseases of Small Bowel, Colon, and Pancreas Flashcards

1
Q

Pts presenting with diverticulitis will have pain where?

A

LLQ –because MC location is sigmoid colon

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2
Q

What is the treatment of diverticulitis?

A

bowel rest
ABX
high-fiber diet

surgery for complications (abscess, perforation)

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3
Q

Diverticular hemorrhage

A

20% of pts with diverticulosis have this

painless bright red bloody stool

MC cause of painless rectal bleeding in elderly

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4
Q

What are the risk factors of diverticular hemorrhage?

A

HTN
smoking
atheroslerosis

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5
Q

What is the treatment for diverticular hemorrhage?

A

localize and treat bleeding via colonoscopy or angiography

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6
Q

What is the likelihood a pt with diverticulitis will have a recurrent episode?

A

if this is their first episode there is a 30% chance

if they have had >2 episodes there is a 50% chance of recurrence

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7
Q

How does a high fiber diet benefit a pt with diverticulosis?

A

increase diameter and decrease wall tension

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8
Q

What are some complications to diverticulitis?

A

fistula
abscess
peritonitis

tx-
IR - percutaneous abscess drainage
surgical resection, debridement, washout, etc.

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9
Q

Blood in the stool in an elderly pt ddx…

A 
diverticulosis 
infectious colitis 
radiation proctitis 
IBD 
colorectal cancer
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10
Q

MC cause of painless rectal bleeding in elderly

A

diverticular hemorrhage

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11
Q

A pt with atherosclerotic disease drops their BP d/t dehydration is at risk of?

A

ischemic colitis

this is the most common scenario

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12
Q

What is the MC cause of ischemic colitis

A

nonocclusive ischemia d/t hypotension

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13
Q

Where is ischemic colitis most commonly located?

A

watershed ares

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14
Q

What is the treatment of mild/moderate ischemic colitis?

A

resuscitation of fluids/BP with IV saline or blood products if bleeding

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15
Q

What is the treatment for severe ischemic colitis?

A

this would be if the pt had necrosis or perforation

laparotomy

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16
Q

Worst abdominal pain of my life

A

acute mesenteric ischemia

pain WAY out of proportion to the exam

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17
Q

How is acute mesenteric ischemia dx?

A

angiogram

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18
Q

Functional Gastrointestinal disorders (FGID)

A

altered motility, sensation, or central control of the GI tract without imaging/structural/mucosal/visible abnormalities

most common is IBS
infant colic

this are hard to treat because we dont know how to treat the problem however after we have ruled out life threatening things we can reassure the pt that it is not going to shorten their life and that we can treat their sxs

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19
Q

“Fibromyalgia of gastroenterology”

A

IBS

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20
Q

ROME 3 Criteria for IBS

A

recurrent abdominal pain or discomfort at least 3days/month in the last 3 months
at least 2 of the following
-pain improves with defecation
-onset associated with a change in bowel habits
-onset associated with a change in stool form

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21
Q

What 2 things do you start with for treated IBS?

A 
fiber diet (30g/day)
probiotics
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22
Q

Which gender is more common to get IBS?

A

Women

there is an association with abuse

23
Q

Microscopic colitis

A

chronic diarrhea
typically in middle aged women
weight loss
normal endoscope

24
Q

Ogilvie Syndrome

A

acute colonic pseudo-obstruction

cecum is dilated d/t back up of feces and gas

25
Q

Who is more likely to get ogilvie syndrome?

A

bed bound pts who have had spinal surgery and received narcotics

26
Q

What is the most common presentation of ogilvie syndrome?

A

abdominal distention

27
Q

What is the treatment for ogilvie syndrome?

A

always start conservative
NEOSTIGMINE

if that does work you can do decompression via colonoscopy

28
Q

What measurement of the colon puts the pt at risk of rupture?

A

> 9cm

29
Q

Alkaline phosphatase

A

these would be elevated if the pt was having acute pancreatitis d/t gallstones

30
Q

What are the major things that cause pancreatitis?

A

Gallstones
EtOH
Meds

31
Q

Which labs will be elevated with acute pancreatitis?

A

amylase rises quickly

lipase rises a bit later

32
Q

Cullens Sign

A

very rare in very severe cases of pancreatitis

bruising around the umbilicus

33
Q

Grey Turner

A

very rare in very severe cases of pancreatitis

bruising around the flanks

34
Q

What is the dx criteria of acute pancreatitis?

A

2 of the 3:

  • abdominal pain consistent with the disease
  • serum amylase and/or lipase greater than 3 times the upper limit of normal
  • abnormal imaging
35
Q

Ranson’s criteria

A

determining the predictive score for a bad outcome with acute pancreatitis

if the pt has 3 or more then they should be admitted and monitored closely in the ICU
vs if they have 1 or 2 criteria they should be fine on the med surg floor

document!

36
Q

When do you drain the pseudocyst?

A

only the pt is have sxs

37
Q

How can you tell infected necrosis on CT?

A

air

38
Q

What is the treatment for acute pancreatitis?

A

IV fluids
bowel rest
pain management
DO NOT follow amylase, lipase –only helpful in dx, not following the course of the dz

39
Q

What is the treatment of acute pancreatitis if the underlying cause if gallstones?

A

cholecystectomy after recovery from pancreatitis

40
Q

During recovery from acute pancreatitis, when should you start feeding them?

A

as soon as the pain improves and the pt wants to eat

start with clear liquids –advance as tolerated

41
Q

When should you use parenteral nutrition?

A

only if the pt has an ileus, cant tolerate food d/t N/V, or not meeting caloric requirements

this is not ideal
we WANT the pt to eat PO

42
Q

What is the most common cause of chronic pancreatitis?

A

EtOH

43
Q

Why are amylase and lipase not elevated in chronic pancreatitis when they are elevated in acute pancreatitis?

A

because the pancreas tissue has been replaced by scar tissue and is unable to produce large amounts of these enzymes anymore

44
Q

What are common presentations of chronic pancreatitis?

A

abdominal pain
steatorrhea
diabetes mellitus
weight loss

calcifications of abdominal x-ray is dx

45
Q

What is the treatment for chronic pancreatitis?

A

PERT - pancreatic enzyme replacement therapy

pain management
stop EtOH
DM treatment

46
Q

Who gets diverticula?

A

Typically greater than 60

M = F

47
Q

Clinical presentation of acute mesenteric ischemia

A

Pain out of proportion to exam

Severe, acute-onset, continue pain; N/V, bloody diarrhea

Surgical emergency

48
Q

How does acute pancreatitis present?

A 
Abdominal pain radiating to the back 
N/V
Agitation 
Abdominal distention 
Guarding

PE:
Cullens
Grey Turner

49
Q

When suspicious of acute pancreatitis, who gets CT and/or MRI?

A

Reserved for pts:

  • in whom the dx is unclear (typical pain with normal enzymes)
  • who fail to improve clinically within the first 48-72 hours after hospital admission
  • to evaluate complications
50
Q

What is the point of Ranson’s criteria?

A

Severity of acute pancreatitis and prognosis

51
Q

What’s the difference between systemic and local complications of acute pancreatitis?

A

Systemic complications - more common within the 1st week

Local complications - more common after the 1st week

52
Q

What is the treatment of acute pancreatitis if the underlying cause is gallstones?

A

Cholecystectomy after recovery from pancreatitis

53
Q

When is ERCP used in acute pancreatitis?

A

With pts have gallstone pancreatitis and concurrent cholangitis

Clin Med 2 (13 decks)

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