Ectopic Pregnancies

Question 1

What is the most common decade for Sigmoid Volvulus occurrence?

Answer 1

8th decade

Predominantly affects older adults.

Question 2

Are males and females equally affected by Sigmoid Volvulus?

Answer 2

Yes

There is no gender predominance.

Question 3

In which types of facilities is Sigmoid Volvulus predominantly found?

Answer 3

Long-term nursing facilities and neuropsych facilities

These environments may contribute to its occurrence.

Question 4

What is the ‘Volvulus belt’ and where is it found?

Answer 4

A region in Africa and the Middle East associated with high fiber diet

This diet increases the risk of Sigmoid Volvulus.

Question 5

What is the third most common cause of colonic obstruction?

Answer 5

Sigmoid Volvulus

Question 6

What pathophysiological condition leads to Sigmoid Volvulus?

Answer 6

Redundant sigmoid colon gets twisted on its mesenteric axis

This can lead to obstruction or infarction.

Question 7

What imaging sign is characteristic of Sigmoid Volvulus on plain film?

Answer 7

Coffee bean sign

Question 8

What imaging sign is characteristic of Sigmoid Volvulus on CT?

Answer 8

Whirl sign

Question 9

What imaging sign is characteristic of Sigmoid Volvulus on a barium enema?

Answer 9

Bird beak sign

Question 10

What are the clinical symptoms of Sigmoid Volvulus?

Answer 10

• Insidious onset
• Constant, severe pain with periods of colicky pain
• Nausea
• Abdominal distention
• Constipation
• Vomiting (later finding)

Symptoms may develop gradually over time.

Question 11

What is the initial non-operative treatment for Sigmoid Volvulus?

Answer 11

Non-operative decompression via rectal tube placement

This is done using a flexible sigmoidoscope.

Question 12

How is the placement of the rectal tube confirmed in Sigmoid Volvulus?

Answer 12

Abdominal x-ray

Question 13

How long should the rectal tube stay in place for Sigmoid Volvulus treatment?

Answer 13

1-2 days

Question 14

What is the elective treatment for Sigmoid Volvulus?

Answer 14

Elective resection

Question 15

What indicates the need for emergent resection in Sigmoid Volvulus?

Answer 15

Signs of necrosis

Question 16

What is the most common location for Ectopic Pregnancy?

Answer 16

Fallopian tubes

This is where most ectopic pregnancies occur.

Question 17

What are the risk factors for Ectopic Pregnancy?

Answer 17

• Documented tubal pathology (PID)
• Surgery to restore tubal patency
• Tubal sterilization
• Prior ectopic pregnancy (10-16x)
• Smoking (>1ppd) (3-4x)
• Advanced maternal age (35-44 y/o) (3x)
• Intrauterine devices (IUD)

These factors significantly increase the risk of ectopic pregnancies.

Question 18

What is the classic triad of symptoms for Ectopic Pregnancy?

Answer 18

• Amenorrhea
• Vaginal bleeding
• Ipsilateral abdominal pain

Question 19

What additional symptoms may present in Ectopic Pregnancy?

Answer 19

• Breast tenderness
• Nausea
• Urinary symptoms
• Shoulder pain (referred)
• Vertigo
• Syncope (hemorrhagic hypovolemia)

Question 20

What is the gold standard for diagnosing Ectopic Pregnancy?

Answer 20

Diagnostic laparoscopy

Question 21

Which laboratory tests are used in the workup for Ectopic Pregnancy?

Answer 21

• Serum beta-hCG level
• Urine beta-hCG level
• Transvaginal ultrasound
• Transabdominal ultrasound
• Culdocentesis

Question 22

What is the medical management for a stable Ectopic Pregnancy?

Answer 22

Methotrexate

It is a folic acid antagonist that inhibits dihydrofolate reductase.

Question 23

What does Methotrexate lead to in the treatment of Ectopic Pregnancy?

Answer 23

Arrest of DNA, RNA, and protein synthesis due to reduction of purines and thymidylate

Question 24

In which cases is laparoscopy preferred over laparotomy for Ectopic Pregnancy?

Answer 24

When the patient is clinically stable and compliant with surveillance