Exam 2 - GI (small bowel) Flashcards
Appendicitis in which decades?
2nd to 3rd
Etiolgoy of appendicitis?
Obstructed lumen of appendix from fecalith
Pathophys stages of appendicitis?
Inflammation->Ischemia->Perforation->Peritonitis.
Pers causes bacterial infx.
Where is pain in appendicitis? (hint: 2 areas)
Periumbilical and epigastric pain
What is Rovsing Sign in appendicitis?
RLQ pain w/LLQ palpation
RLQ pain w/LLQ palpation is which sign?
Rovsing
What is Psoas Sign in appendicitis?
RLQ pain with passive right hip extension
Which sign is RLQ pain w/passive right hip extension?
Psoas Sign
What is Obturator Sign in appendicitis?
RLQ pain internal rotation of w/bent (flexed) knee
Whch sign is RLQ pain internal rotation of w/bent (flexed) knee?
Obturator sign
What is McBurney’s Tenderness Sign in appendicitis?
Tenderness 1/3 distance from ASIS to navel
Which sign is tenderness 1/3 distance from ASIS to navel?
McBurney’s Tenderness Sign
How to DX appendicitis?
CT of abdomen. Also ultrasound.
CBC shows what in appendicitis?
Leukocytosis
Tx of appendicitis?
NPO, IV fluid resus. IV abx for broad sprecrum anareobes or aerobes.
O.R. appendectomy
What is etiology of Mesenteric Ischemia?
SMA occlusion in 60%. Embolic or thrombus.
Non-occlusive=CAD, shock, poor perfusion
Which part of intestine involved in Mesenteric Ischemia?
Ischemia of SMALL BOWEL
PE finding in Mesenteric Ischemia? (Hint: proportion)
Severe pain out of proportion to physical exam findings!
Severe pain out of proportion fo physical exam findings is which condition?
Mesenteric Ischemia
Location and quality of pain in Mesenteric Ischemia?
Rapid onset of severe unrelenting periumbilical pain
PT feels Bowel needs what in Mesenteric Ischemia?
Forceful/urgent need to evacuate bowel
What seen in Mesenteric Ischemia when ischemia to infarction?
Peritoneal signs and fever
Test of choice in Mesenteric Ischemia?
Mesenteric angiography. Can ID type of acute mesenteric ischemia.
Tx in Mesenteric Ischemia?
Resus with fluids and blood. Anticoagulation if clot. Infuse vasodilator with systemic Glucagon or Papaverine via catheter.
Which meds to use for vasodilation in Mesenteric Ischemia?
IV Glucagon or Papaverine via catheter
Tx if ischemia to infarct in Mesenteric Ischemia?
Emergent laparatomy. Restore blood flow. Resect bowel if infarcted.
What to do is bowel infarcted in Mesenteric Ischemia?
Resect bowel
What is the most common form of Mesenteric Ischemia?
Ischemic Colitis
Where does in Ischemic Colitis occur?
Left colon (splenic flexure and rectosigmoid juncture)
Who mostly gets Ischemic Colitis?
Elderly
Etiologies of in Ischemic Colitis? (hint: 2)
Hypotension (low flow), thrombus
Where is pain and tenderness with in Ischemic Colitis?
LLQ pain w/tenderness
Bloody diarrhea in Ischemic Colitis due to what?
Sloughing colon
What sort of acidosis in Ischemic Colitis?
Metabolic acidosis
How to dx Ischemic Colitis?
Endoscopy (colonoscopy)
Tx of Ischemic Colitis?
Supportive care.
Tx of Ileus in Ischemic Colitis?
Nasogastric tube
Tx of Ischemic Colitis if fail supportive care?
Laparotomy w/resection
Etiologies of Toxic Megacolon?
IBD (Chron’s, UC), bacterial, parasitic, viral
What happens size to colon in Toxic Megacolon?
Colonic dilation
Pathophys of Toxic Megacolon?
Total or segmental non-obstructive colonic dilation + systemic toxicity.
Inflammation->NO- Synthase->paralysis of colonic smooth muscle->dilation
Abdomen in Toxic Megacolon?
Distended
Sx of Toxic Megacolon?
N/V/D, tenessmus
What can happen to electrolytes in Toxic Megacolon?
Disturbed
PE of Toxic Megacolon?
Fever, dehydration, hypotension, tachy, WBC >10.5
Dx of Toxic Megacolon?
Abd x-ray.
>6cm dilated colon
First-line tx of Toxic Megacolon?
Non-operative. IV fluids, fix lytes, broad spectrum abx, IV corticosteroids, NPO, bowel decompression w/NGT
Tx of fail first-line tx in Toxic Megacolon?
Subtotal colectomy w/end-ileostomy
What is #1 cause of Small Bowel Obstruction?
Post-op adhesion!
Sx of Small Bowel Obstruction?
Abd pain, N/V
What happens to stool and flatulus in Small Bowel Obstruction?
NO MOVEMENT!
Bowel sounds in early Small Bowel Obstruction?
Hyperactive
Bowel sounds in late Small Bowel Obstruction?
Hypoactive
What is visable in Small Bowel Obstruction?
Visible peristalsis
Dx of Small Bowel Obstruction?
Abd x-ray. Air/fluid levels in step-ladder pattern showing dilated bowel.
What will abdominal x-ray show in Small Bowel Obstruction?
Air/fluid levels in step-ladder pattern showing dilated bowel.
What is an Ileus?
Inability of intstine/bowel to contract normally and move poop out of body
What is a Post-Op Paralytic Ileus?
Obstibation (severe constipation) and intolerance of PO intake d/t non-mechanical insult which disrupts normal motor activity of GI tract.
Non-mechanical insult which disrupts normal motor activity of GI tract due to what?
Post-op paralytic ileus
Step-ladder pattern associated with what?
Small Bowl Obstruction abd xray findings
Tx of Small Bowel Obstruction?
NPO, IV fluids, nasal gastric tube to decompress bowel
What age gets Pancreastic Cancer?
Rarely below 45 y/o
Rish factors for Pancreastic Cancer?
Chronic pancreatitis, smoking, DM, FHx
What is main cause of Pancreastic Cancer?
Ductal adenocarcinoma!!
Where is ductal adenocarcinoma located to in Pancreastic Cancer?
Head, neck, and uncinate of pancreas
What type of DM can Pancreastic Cancer cause?
Atypical DM
Sx of Pancreastic Cancer?
Jaundice, weight loss, pain
What is Courvoisier Sign in Pancreastic Cancer??
Nontender palpable gall bladder with jaundice
Late Pancreastic Cancer sign in abdomen?
Palpable mass and ascites
Dx of Pancreastic Cancer? TOC?
CA 19-9.
Increased pancreatic tumor markers.
TOC=CT of abdomen
By the time Pancreastic Cancer discovered what has likely happened?
Mets to liver, peritoneum, lungs, and adrenal glands
Tx of Pancreastic Cancer if stage I-IIb
Surgery
Tx of Pancreastic Cancer if tumor in head of pancreas?
Whipple procedure
What does chemo do in Pancreastic Cancer?
May improve short-term survivial only.
