Disorders of the Intestines, Colon, Rectum Flashcards
Your patient is a 19 year old female complaining of pain that started “around my belly button” but now is in the RLQ. What three physical exam techniques are you going to perform?
suspected appendicitis
- palpate McBurney’s point for tenderness
- elicit psoas sign (pain on passive extension of right hip)
- elicit obturator sign (pain on passive flexion and internal rotation of right hip)
Given its frequency and myriad presentations, appendicitis should be considered in the ddx of all patients with abdominal pain.
T/F
TRUE
What is the difference between paralytic ileus and small bowel obstruction?
paralytic ileus is neurogenic - no actual obstruction
small bowel obstruction is mechanical - actual blockage due to hernia, stricture, adhesion, volvulus
What types of things precipitate paralytic ileus?
abdominal surgery, peritoneal irritation, respiratory failure requiring intubation, electrolyte abnormalities, medications that slow intestinal motility (opioids, anticholinergics)…
Things that “piss the intestines off”
What does the xray of paralytic ileus look like?
distended, gas-filled loops of small and large intestine
maybe see air-fluid levels
Your patient is a 22 year old woman with a history of depression and anxiety. Three months ago she had an episode of bacterial gastroenteritis. Today she says that she has abdominal pain, changes in her frequency and consistency of stools, bloating, and stress. You perform an endoscopy and take some xrays, but there is nothing notable. What are you thinking?
irritable bowel syndrome
What is the first treatment you try for your patient with irritable bowel syndrome?
Dietary journaling and avoidance of trigger foods; most patients poorly tolerate fatty foods, caffeine, and fermentable carbs (e.g. fructose, breads, pasta)
More than two-thirds of irritable bowel syndrome patients respond to education, reassurance, and dietary changes. But if not, what drugs will you try?
- antispasmodics: dicyclomine, hyoscyamine
- antidiarrheals: loperamide
- anticonstipation: osmotic laxatives e.g. MOM or polyethylene glycol
- psychotropics: tricyclic antidepressants
- 5-HT antagonist: alosetron
- probiotics
A congenital anomaly in which an outpouching of the intestine derived from the fetal yolk sac contains ectopic gastric or pancreatic tissue that can secrete enzymes that erode the mucosa, causing bleeding.
Meckel diverticulum
Mr. Edwards is a 52 year old gentleman presenting to clinic today with LLQ tenderness and a palpable mass, low-grade fever, and nausea. In taking his hx you find that his diet is very low in fiber and has been for years.
~What do you suspect?
~What are you going to NOT do?
~How will you treat him?
~diverticulitis, mild flare
~NO endoscopy or colonography during initial acute attack (risk of perforation)
~outpatient; clear liquid diet and empiric broad-spectrum abx with anaerobic activity
What is the USPSTF recommendation regarding colon cancer screening?
- FOB/sigmoidoscopy/colonoscopy from age 50 to age 75 (A)
- Against routine screening age 76 - 85; in certain individual patients maybe it would be considered (C)
- Against screening age 85+; don’t do it (D)
American Cancer Society recommendations for colon cancer screening:
FOBT or FIT every year (take home method) OR
Sigmoidoscopy, double-contrast barium enema, or CT colonography every 5 years OR
Colonoscopy every 10 years
Your mentor tells you to tell the patient to roll side to side and onto their abdomen. Why?
toxic megacolon - trying to decompress the distended colon
What is the firstline treatment for C.diff?
metronidazole
What is the treatment for severe C.diff?
vancomycin
This is a malabsorption syndrome usually caused by having part of the colon removed, e.g. for Crohn, volvulus, or bariatric surgery.
short bowel syndrome
True pseudomembranous colitis is seen in severe what?
C. diff infection
Your patient is a female PA complaining of high frequency (10-20x/day) and volume watery diarrhea both during the day and at night. Upon stool analysis you find an osmotic gap, which is unusual for secretory diarrhea. What is it?
laxative abuse
What is a major difference between IBS and IBD?
IBS does NOT cause inflammation
–>IBS pts show no signs of disease or abnormalities when colon is examined
What causes irritable bowel syndrome?
idiopathic
3 types of inflammatory bowel disease?
- ulcerative colitis
- crohn disease
- toxic megacolon
What is the hallmark of ulcerative colitis?
bloody diarrhea
T/F: ulcerative colitis severity may be LOWER in active smokers and may worsen in pts who stop smoking.
TRUE
Mild to moderate ulcerative colitis s/s?
mild:
-intermittent rectal bleeding and mucus
-fecal urgency
-no significant abd tenderness
moderate:
-more severe diarrhea and frequent bleeding
-abd pain present but not severe
Severe ulcerative colitis s/s?
> 6 bowel movements/day
- severe anemia, hypovolemia, impaired nutrition
- hypoalbuminemia
- abdominal pain and tenderness
Two goals of treatment of ulcerative colitis?
- terminate the acute, symptomatic attack
2. prevent recurrence of attacks
What are ulcerative colitis (dz proximal to rectum) and Crohns more likely to get?
markedly increased risk of colon carcinoma
s/s Crohn Disease?
- abdominal pain
- liquid bowel movements (sometimes bloody)
- abdominal tenderness or abdominal mass
There are 5 clinical constellations of Crohn Dz: name them
- chronic inflammatory dz
- intestinal obstruction
- penetrating disease and fistulas
- perianal disease
- extraintestinal manifestations
s/s chronic inflammatory dz
- malaise, loss of energy
- diarrhea, non bloody, intermittent
- cramping or steady RLQ / periumbilical pain
- focal tenderness, RLQ
- palpable, tender mass in lower abdomen
s/s intestinal obstruction
- postprandial bloating, cramping pains, and loud borborygmi
- narrowing of the small bowel may occur as a result of inflammation, spasm, fibrotic stenosis
What are some extraintestinal manifestations of Crohn Dz?
- arthralgias, arthritis
- iritis or uveitis
- pyoderma gangrenosum
- erythema nodosum
- oral aphthous lesions
- gallstones
- nephrolithiasis with stones
Colorectal cancer is most common among (blacks, Hispanics, whites)
blacks
__% of Native Americans are lactose intolerant.
__% of Asian Americans are lactose intolerant.
__% of African Americans are lactose intolerant.
95% of Native Americans
90% of Asian Americans
70% of African Americans
