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
