Diseases of Small Bowel, Colon, and Pancreas

Question 1

Pts presenting with diverticulitis will have pain where?

Answer 1

LLQ –because MC location is sigmoid colon

Question 2

What is the treatment of diverticulitis?

Answer 2

bowel rest
ABX
high-fiber diet

surgery for complications (abscess, perforation)

Question 3

Diverticular hemorrhage

Answer 3

20% of pts with diverticulosis have this

painless bright red bloody stool

MC cause of painless rectal bleeding in elderly

Question 4

What are the risk factors of diverticular hemorrhage?

Answer 4

HTN
smoking
atheroslerosis

Question 5

What is the treatment for diverticular hemorrhage?

Answer 5

localize and treat bleeding via colonoscopy or angiography

Question 6

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

Answer 6

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

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

Question 7

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

Answer 7

increase diameter and decrease wall tension

Question 8

What are some complications to diverticulitis?

Answer 8

fistula
abscess
peritonitis

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

Question 9

Blood in the stool in an elderly pt ddx…

Answer 9

diverticulosis 
infectious colitis 
radiation proctitis 
IBD 
colorectal cancer

Question 10

MC cause of painless rectal bleeding in elderly

Answer 10

diverticular hemorrhage

Question 11

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

Answer 11

ischemic colitis

this is the most common scenario

Question 12

What is the MC cause of ischemic colitis

Answer 12

nonocclusive ischemia d/t hypotension

Question 13

Where is ischemic colitis most commonly located?

Answer 13

watershed ares

Question 14

What is the treatment of mild/moderate ischemic colitis?

Answer 14

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

Question 15

What is the treatment for severe ischemic colitis?

Answer 15

this would be if the pt had necrosis or perforation

laparotomy

Question 16

Worst abdominal pain of my life

Answer 16

acute mesenteric ischemia

pain WAY out of proportion to the exam

Question 17

How is acute mesenteric ischemia dx?

Answer 17

angiogram

Question 18

Functional Gastrointestinal disorders (FGID)

Answer 18

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

Question 19

“Fibromyalgia of gastroenterology”

Answer 19

IBS

Question 20

ROME 3 Criteria for IBS

Answer 20

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

Question 21

What 2 things do you start with for treated IBS?

Answer 21

fiber diet (30g/day)
probiotics

Question 22

Which gender is more common to get IBS?

Answer 22

Women

there is an association with abuse

Question 23

Microscopic colitis

Answer 23

chronic diarrhea
typically in middle aged women
weight loss
normal endoscope

Question 24

Ogilvie Syndrome

Answer 24

acute colonic pseudo-obstruction

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

Question 25

Who is more likely to get ogilvie syndrome?

Answer 25

bed bound pts who have had spinal surgery and received narcotics

Question 26

What is the most common presentation of ogilvie syndrome?

Answer 26

abdominal distention

Question 27

What is the treatment for ogilvie syndrome?

Answer 27

always start conservative NEOSTIGMINE if that does work you can do decompression via colonoscopy

Question 28

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

Answer 28

>9cm

Question 29

Alkaline phosphatase

Answer 29

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

Question 30

What are the major things that cause pancreatitis?

Answer 30

Gallstones EtOH Meds

Question 31

Which labs will be elevated with acute pancreatitis?

Answer 31

amylase rises quickly | lipase rises a bit later

Question 32

Cullens Sign

Answer 32

very rare in very severe cases of pancreatitis bruising around the umbilicus

Question 33

Grey Turner

Answer 33

very rare in very severe cases of pancreatitis bruising around the flanks

Question 34

What is the dx criteria of acute pancreatitis?

Answer 34

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

Question 35

Ranson's criteria

Answer 35

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!

Question 36

When do you drain the pseudocyst?

Answer 36

only the pt is have sxs

Question 37

How can you tell infected necrosis on CT?

Answer 37

air

Question 38

What is the treatment for acute pancreatitis?

Answer 38

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

Question 39

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

Answer 39

cholecystectomy after recovery from pancreatitis

Question 40

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

Answer 40

as soon as the pain improves and the pt wants to eat | start with clear liquids --advance as tolerated

Question 41

When should you use parenteral nutrition?

Answer 41

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

Question 42

What is the most common cause of chronic pancreatitis?

Answer 42

EtOH

Question 43

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

Answer 43

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

Question 44

What are common presentations of chronic pancreatitis?

Answer 44

abdominal pain steatorrhea diabetes mellitus weight loss calcifications of abdominal x-ray is dx

Question 45

What is the treatment for chronic pancreatitis?

Answer 45

PERT - pancreatic enzyme replacement therapy pain management stop EtOH DM treatment

Question 46

Who gets diverticula?

Answer 46

Typically greater than 60 | M = F

Question 47

Clinical presentation of acute mesenteric ischemia

Answer 47

Pain out of proportion to exam Severe, acute-onset, continue pain; N/V, bloody diarrhea Surgical emergency

Question 48

How does acute pancreatitis present?

Answer 48

``` Abdominal pain radiating to the back N/V Agitation Abdominal distention Guarding ``` PE: Cullens Grey Turner

Question 49

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

Answer 49

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

Question 50

What is the point of Ranson’s criteria?

Answer 50

Severity of acute pancreatitis and prognosis

Question 51

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

Answer 51

Systemic complications - more common within the 1st week Local complications - more common after the 1st week

Question 52

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

Answer 52

Cholecystectomy after recovery from pancreatitis

Question 53

When is ERCP used in acute pancreatitis?

Answer 53

With pts have gallstone pancreatitis and concurrent cholangitis